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)

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

The aim of the present study was to describe co-activity patterns of the striated urethral wall muscle and the pelvic floor muscles (PFM) during contraction of outer pelvic muscles. Six healthy nulliparous physical education students, mean age 19.5 years (19-21) participated in the study. Concentric needle EMG and a Dantec amplifier were used for registrations. EMG activity was continuously recorded with the participants lying in a supine position. EMG was recorded during relaxation, contraction of the PFM, valsalva maneuver, coughing, hip adductor contraction, gluteal muscle contraction, backward tilting of the pelvis, and sit-ups. The procedure was performed with the needle in the striated muscle of the anterior wall of the urethra and then repeated with the needle set lateral to the urethra in the PFM. The results showed that the striated urethral wall muscle was contracted synergistically during PFM, hip adductor, and gluteal muscle contraction, but not during abdominal contraction. Both hip adduction, gluteal muscle, and abdominal muscle contraction gave synergistic contraction of the PFM. Thus the urethral wall striated muscle and the PFM react differently during abdominal contraction.
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PMID:Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, Valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. 815 73

The effect of autonomic receptor agonists and antagonists on the urethral pressure and power generation during coughing and squeezing of the pelvic floor has been evaluated in 30 healthy females. The measurements were carried out at the bladder neck, in the high pressure zone, and distally in the urethra. The used drugs (noradrenaline, prazosin, terbutaline, propranolol, carbachol and atropine) caused no significant change in the pressure and power generation. The clinically relevant influence of drugs on the urethral closure function should be re-appraised when based on profilometry in the resting state. The results support that the effect of the autonomic nervous system on the urethral closure function is insignificant in healthy women. They furthermore indicate that investigations on the ability to secure continence cannot be based solely on resting pressure profilometry, but should be accomplished by measurements during stress episodes.
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PMID:The effect of pharmacological stimulation and blockade of autonomic receptors on the urethral pressure and power generation during coughing and squeezing of the pelvic floor in healthy females. 815 24

Continence in women, ensured by a constantly positive urethral closing pressure, is the result of two phenomena: purely passive factors (urethral pressure and compliance, transmission of bladder pressure to the urethra) and active factors mediated by a voluntary and reflex neuromuscular mechanism (contraction, reflexivity, sphincter endurance). In order to define these active forces of continence, we simultaneously studied the quantitative electromyographic activity of the striated sphincter and the bulbocavernosus muscle and variations in the urethral and vesical pressure under various conditions (rest, coughing, stimulation of the pudendal nerve). During coughing, the urethral pressure peak occurred earlier (100 milliseconds) than the vesical peak, associated with hypertransmission of 20%, the bulbocavernosus muscle contracted first, followed by contraction of the striated urethral sphincter (150 ms delay) and this electrical activity preceded the rise in vesical and urethral pressures. Stimulation of the pudendal nerve eliminated the possibility of an artefact related to coughing and induced the same sequence of events.
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PMID:[The active forces of continence. Illustration by quantified analysis of the electromyographic signal of the urethral striated sphincter combined with urethral pressure studies]. 848 88

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

Stress urinary incontinence is a symptom that arises from damage to the muscles, nerves, and connective tissue of the pelvic floor. Urethral support, vesical neck function, and function of the urethral muscles are important determinants of continence. The urethra is supported by the action of the levator ani muscles through their connection to the endopelvic fascia of the anterior vaginal wall. Damage to the connection between this fascia and muscle, loss of nerve supply to the muscle, or direct muscle damage can influence continence. In addition, loss of normal vesical neck closure can result in incontinence despite normal urethral support. Although the traditional attitude has been to ignore the urethra as a factor contributing to continence, it does play a role in determining stress continence since in 50% of continent women, urine enters the urethra during increases in abdominal pressure, where it is stopped before it can escape from the external meatus. Perhaps one of the most interesting yet least acknowledged aspects of continence control concerns the coordination of this system. The muscles of the urethra and levator ani contract during a cough to assist continence, and little is known about the control of this phenomenon. That operations cure stress incontinence without altering nerve or muscle function should not be misinterpreted as indicating that these factors are unimportant.
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PMID:The pathophysiology of stress urinary incontinence in women and its implications for surgical treatment. 937 77

Urethral function can be assessed using many different techniques and this is very important when applied to women with neurological abnormalities. Urethral pressure profilometry, although not diagnostic for urethral sphincter incompetence, can be used to detect strictures and the ostia leading to urethral diverticula. Urethral instability may be recorded using urethral pressure catheters. The significance of this finding is uncertain but it has been suggested that women with urethral instability and detrusor instability are less responsive to therapy with anticholinergic drugs than those with a stable urethra. Micturition pressure profilometry is useful for determining obstruction during voiding and enables the site of obstruction to be determined. Leak point pressures (LPP) can be classified as detrusor or abdominal. Detrusor LPP are useful in patients with neurological disease. Abdominal LPP are subdivided according to the method used to increase intra-abdominal pressure either the Valsalva manoeuvre or coughing. The technique used to obtain an LPP can alter the measurement obtained and a standardized technique is essential for consistent results. LPP correlate with the urinary incontinence of women with genuine stress incontinence undergoing a pad test but is of no value if the woman does not leak! Tests of urethral function during bladder filling, stress and voiding phases help in assessing lower urinary tract dysfunction in neurourology.
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PMID:The urethra (UPP, MUPP, instability, LPP). 970 49

The aim of this study was to analyze the urethral pressure responses to cough in men to better characterize the neurogenic mechanisms of male urethral function. A prospective study was carried out on 41 men referred for urodynamic assessment. Urethral pressure profiles at rest and during coughing, and urethral pressure response to voluntary perineal contraction were recorded and analyzed in relation to the neurological status of the patients. Voluntary perineal contraction resulted in a urethral pressure increase (delta pU) of approximately 150 cm H2O in neurologically normal patients. Delta pU could be reduced to any degree in patients with either central or peripheral neurological lesions. Urethral pressure response to cough could be easily classified into two main patterns. Pattern I was characterized by a marked increase in urethral closure pressure during the cough (ratio of urethral to rectal pressure increase: 248 +/- 106%), occurring at the distal part of the posterior urethra. All the neurologically normal patients and the majority of those with upper motoneuron lesions had a pattern I response. Pattern II was defined by the absence of any significant increase in urethral closure pressure at any site of the posterior urethra and was observed in 80% of the patients with signs of lower motoneuron lesions. The pattern of the response to cough was significantly related to the neurological status of the patients (P < 0.001). It was dissociated from the response to voluntary contraction, as would be expected for a reflex versus a voluntary response in neurological patients.
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PMID:Urethral pressure response to cough and voluntary perineal contraction in men without previous pelvic surgery. 1008 49

This paper compares urethral profilometry measurements using two different types of catheter: the Millar microtip transducer and the FST fiberoptic catheter. Outcome variables were functional urethral length (FUL), maximum urethral closure pressure (MUCP), and mean pressure/transmission ratio (PTR). Thirty women presenting to the urodynamics laboratory with symptoms of stress urinary incontinence were evaluated with both catheters. All subjects underwent two passive urethral pressure profiles and two dynamic (cough) urethral pressure profiles with each catheter. For FUL and MUCP, the means of the two passive measurements were compared between catheters. For PTR, the means of the two dynamic measurements were compared between catheters. There was no difference in FUL between the two catheter types. The FST measurements of MUCP and PTR were lower than the microtip measurements. Twenty percent of patients would have been diagnosed with low-pressure urethra with the FST catheter, but not with the microtip catheter. Caution must be used when applying urethral measurements taken with the fiberoptic catheters to standards set with microtip catheters.
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PMID:A comparison of urethral profilometry using microtip and fiberoptic catheters. 1061 72

The aim of this prospective study was to evaluate the influence of the higher intra-abdominal position of the bladder neck and the stability of its supporting structures after colposuspension, on pressure transmission to the urethra at the level of the bladder neck. Twenty-eight patients were included in the study. The pressure transmission ratio (PTR) was calculated at the level of the bladder neck, whereas the position and mobility of the bladder neck during coughing were evaluated with perineal ultrasound examination. The measurements were performed before and 3 months after colposuspension. After colposuspension we found a significant elevation of the PTR (P=0.001), a significantly higher intra-abdominal position (P=0.001) and decreased mobility (P=0.001) of the bladder neck during coughing. Also, a negative correlation between the elevation of PTR and decreased mobility of the bladder neck during coughing (r = -0.5049; P = 0.006) and a weak correlation between the elevation of PTR and a higher intra-abdominal position of the bladder neck during coughing were found (r = 0.3828; P=0.044). Reinforced tension resistance of the bladder neck supporting structures seems to be more important than intra-abdominal position of the bladder neck in achieving effective pressure transmission after colposuspension.
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PMID:Effect of intra-abdominal position of the bladder neck and stability of its supporting structures on pressure transmission ratio after colposuspension. 1080 67


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