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

From a questionnaire survey dealing with urinary incontinence during pregnancy and after childbirth 62 women were randomly selected. These women underwent simultaneous urethrocystometry including urethral profile measurement 7--14 days after parturition. From the case history two groups of patients could be distinguished. One group consisted of women who experienced only occasionally urine leakage after delivery. Pressure recordings in these previous patients were normal, moreover the urethral closure pressure was positive, also at cough provocations. The urethral length and pressure were similar to that found in continent females. The other group of patients reported stress incontinence of a more serious and permanent nature; the symptoms did not disappear after delivery. In all these women negative urethral closure pressures were recorded at cough provocations and simultaneously leakage of urine from the urethra was observed. In addition the urethral length was shorter and urethral resting pressure lower than that recorded in the first group of patients. The reversible symptoms in the first group of women may be a consequence of the pressure exerted by the uterus upon the bladder at coughing combined with a hormonal relaxation of the urethral suspension. In the second group, the enduring symptoms suggest irreversible damage to the urethra and its suspension system during pregnancy.
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PMID:Postpartum incontinence. 719 4

The fluid-bridge test (FBT) detects the entry of urine into the proximal urethra during coughing. In this study it was applied in the investigation of incontinent patients when they were first supine and then standing up. The test results in 76 women with urinary incontinence and 27 women with normal urinary control are reported. When the test was performed erect at 0.5 cm from the urethrovesical junction, it was positive in 68 (90%) of the study group and 4 (15%) of the controls. The difference between the results in the 2 groups is highly significant (P less than 0.001). In 12 (16%) of the incontinent group the test at 0.5 cm became positive only when the subject was standing up, indicating that erect testing adds to the diagnostic efficiency of the method. Erect testing seems more relevant to the investigation of stress urinary incontinence. This study has shown that this is possible using simple urodynamic apparatus.
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PMID:Detection of urethral incompetence. Erect studies using the fluid-bridge test. 719 73

The objective of the study was to ascertain if the determination of urethral data in static conditions allows to discriminate between sphincter and detrusor incontinence. Using a standardized recording technique with three Millar microtransducer catheters (in bladder, urethra and rectum) urethral pressure profile measurements were done in two groups of female patients, with either sphincter incontinence (n = 38) or detrusor incontinence (n = 28). The urethral examination was performed in two conditions, with an empty bladder when the patient was in supine position and with a full bladder in standing position. A Millar catheter with a small balloon was drawn through the urethra at a speed of 25 mm per minute (static, i.e. without coughing). The parameters measured were the functional urethral length, the anatomical urethral length and the maximal urethral closure pressure. Results showed that there was no clear difference between both groups with respect to the urethral lengths or the maximal closure pressure. Comparing the data in the condition of empty bladder supine, with those in the condition of full bladder standing, we could not demonstrate clear specificity for either sphincter or detrusor incontinence. It was concluded that static urethral profile studies are of poor value to discriminate between sphincter incontinence and detrusor incontinence.
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PMID:The static urethral closure pressure profile in female incontinence. A comparison between sphincter and detrusor incontinence. 719 29

The objective of this study was to develop and preliminarily test the measuring principle suitable for quantification of the capability of deformation of the inner urethral wall, i.e. quantification of inner urethral wall softness. The special measuring catheter was made of plexiglass with two conically shaped stainless steel electrodes mounted 5 cm from its distal tip. The principle of indirect compression measurement on the basis of impedance changes between the electrodes due to the introduction of the tissue between them was tested. The changes in impedance were measured in the distal male urethra during external manual compression, and in the anal sphincter during voluntary contractions and during coughing. The results obtained confirm the applicability as well as the significance of a further perfection of the new method. Calibration technique of the transducer was developed and tested in NaCl solution.
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PMID:How to measure inner urethral wall softness. 719 30

We localized the temporal and spatial distribution of pressures in the urethra to identify their contribution to continence. With the data obtained we resolved the timing between the passively transmitted and actively generated urethral pressures. Data were obtained from 11 healthy female volunteers, with a mean age of 22 years. Simultaneous measurements of bladder and urethral pressures were taken from subjects during the Valsalva maneuver and coughing, and then holding with the subject in the supine, standing and sitting positions. The ratio of urethral to bladder pressure increase and the latency between these pressure increases were analyzed. A biphasic pressure distribution results from coughing with subjects in all positions. The first phase occurs at the normalized distance of 10 to 15 per cent from the bladder neck, where the ratio of urethral to bladder pressure increase is 0.8. The second phase occurs at 60 to 70 per cent of the urethral length and has a 1.5 to 1.7 ratio of urethral to bladder pressure increase, indicating the presence of pressure magnification. Simultaneous latency measurements indicate that the pressure increase in the urethra precedes that of the bladder by 240 plus or minus 30 msec. in the region that exhibits maximum pressure magnification. These results indicate that a fast-acting contraction occurs in the distal third of the urethra, which contributes reflexly to the compressive forces of the proximal urethra, thereby preventing urine loss during stress.
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PMID:Spatial distribution and timing of transmitted and reflexly generated urethral pressures in healthy women. 720 Oct 31

The aim of the study was to determine the contribution of intra-abdominal pressure transmission to urinary continence in the female. Five patients with genuine stress incontinence (GSI) were studied. Pressure transmission was measured in equivalent positions inside and outside the urethra and bladder during the Intravaginal Slingplasty procedure, a surgical operation used for treatment of urinary incontinence, and performed under local anaesthesia. A 6 mm diameter channel was created alongside the urethra. Two separate microtransducer catheters appropriately marked for length were inserted, one inside the urethra, and the other inside the described channel. With the vaginal hammock intact, an average of 10 simultaneous pressure measurements were made intraoperatively in response to coughing and straining in equivalent positions inside the urethra, and directly outside. Significantly higher pressure readings were found inside the urethra (P = 0.0025), indicating that an active component within the urethra may have created this pressure rise. After opening out two suburethral vaginal flaps, large quantities of urine were lost on coughing in all patients. Continence was achieved on tightening the suburethral vagina, indicating that an adequately tight vaginal hammock is a critical element in the continence process. The findings of this study question intraabdominal pressure as a mechanism contributing to continence, but support an alternative mechanism, musculovaginal closure of the urethra.
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PMID:Urethral pressure increase on effort originates from within the urethra, and continence from musculovaginal closure. 891 19

The author endeavours to detail the technical modalities which can be used to avoid uncertainty in urodynamic sonography, and to obtain easily reproducible quality imaging. The 5 major techniques (transparietal, transperineal, introital, endovaginal and endorectal) are compared. The artifacts generated are described. A choice between these different techniques is performed as a function of the methodological advantages specific to each of them and the clinical applications contemplated by the sonographer. The characteristics of the "ideal" equipment are defined to help the sonographer-to-be to choose his or her equipment with full awareness of the facts (characteristics of the probe, emission frequency, settings by the sonographer, automatic image freeze during coughing). The methodology is described in detail and widely illustrated: position of the patient, choice of the section plane, choice of the reference system, location of the urethra, and definition of the vesical neck, maintenance of the probe position during effort or free movement, degree of vesical fullness, choice of the parameters. Some difficulties can be linked to the patient's anatomical characteristics (vaginal scar, short or narrow vagina, twisted urethra,...); ways to avoid them are briefly described.
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PMID:Reducing uncertainty for vesico-urethral sonography in women. 778 33

The effect of bilateral pudendal blockade on the urethral pressure and power generation during coughing and pelvic floor squeezing was evaluated in 10 healthy women. The measurements were carried out at the bladder neck, in the high pressure zone, and distally in the urethra before and after blockade. Strong adjunctive closure forces were demonstrated all along the urethra. They were significantly reduced by pudendal blockade except at the bladder neck during coughing. The results indicate that the pudendal innervated striated muscles contribute significantly to the adjunctively acting closure forces all along the female urethra, including the bladder neck. Some passive pressure transmission to the bladder neck seems to take place during stress episodes following pudendal blockade, but whether it occurs in healthy females remain uncertain. The findings following pudendal blockade, corroborate with those in stress incontinent women, and thereby support the concept that striated muscle weakness is of pathophysiological significance in stress urinary incontinence.
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PMID:The effect of bilateral pudendal blockade on the adjunctive urethral closure forces in healthy females. 781 67

The surgical management of urinary incontinence due to sphincter incompetence is still a challenging issue for urologists to date. We reviewed our experience with the fascial sling performed in 10 male and 3 female patients 3 to 72 years old (median age 13 years) with sphincter incompetence, including 11 with a neurogenic bladder (8 with myelodysplasia, 2 after pelvic operation and 1 after spinal cord injury), 1 after transurethral resection of the prostate and 1 after surgical injury to the bladder neck. Patient selection for a sling procedure was based on cystography (an open bladder neck) and urodynamic findings (underactive external urethral sphincter on electromyography and low maximum urethral closure pressure). A free graft of fascia was harvested from the rectus fascia in 8 patients and from the fascia lata in 5, and the fascial sling was placed around the bladder neck in 11 and the bulbous urethra in 2. Augmentation cystoplasty was performed concomitantly in 9 patients with poor bladder compliance (8 ileocystoplasty and 1 gastrocystoplasty). Postoperative followup ranged from 4 to 63 months (mean 36). Nine patients became continent and 3 improved significantly but remain damp. Of these 12 patients 10 with a neurogenic bladder were placed on intermittent catheterization, while the 2 without a neurogenic bladder are able to void normally. The remaining patient with surgical failure due to inadvertent wound infection received an indwelling urethral catheter. In all but this patient preoperative and postoperative maximum urethral closure pressures were 34.3 +/- 5.7 and 37.2 +/- 3.8 cm. water, respectively, without a significant increase. However, postoperative simultaneous measurements of intravesical and intraurethral pressure demonstrated a dramatic increase in intraurethral pressure during coughing or straining because of the action of the sling. Postoperative upper urinary tract deterioration has not been documented to date. Although various surgical options have been available, the fascial sling seems to be promising in the management of refractory urinary incontinence due to sphincter incompetence.
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PMID:Fascial sling for the management of urinary incontinence due to sphincter incompetence. 786 5

The exact demands on urodynamic equipment for measurement of coughs and cough associated pressure changes in the lower urinary tract have been analyzed from high-speed pressure recordings using a double microtip transducer and a storage oscilloscope. The equipment was tested in vitro by the step-test method. The natural frequency response was 175.6 Hz and the rise-time 2.5 ms, resulting in accurate measurements of frequencies up to about 60 Hz, which is way above the clinically measured frequencies. Four men and 2 women, all of whom were healthy volunteers, were examined in the supine position with an empty bladder. Pressures were measured in the bladder and in the external sphincter zone of the urethra. The spectral power density of the bladder and urethral pressures were calculated by Fourier analysis. The pressure changes in the urethra were in all volunteers equal to or slower than in the bladder. The analysis of the spectral power density showed that 99% of the pressure changes could be recorded with an instrument capable of recording 9 Hz frequencies, i.e., with a sampling rate of 18 Hz or more.
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PMID:Characterization of pressure changes in the lower urinary tract during coughing with special reference to the demands on the pressure recording equipment. 792 Jun 78


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