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

It is widely accepted that preoperative evaluation of women with stress urinary incontinence should include an assessment of urethrovesical mobility. In the last few decades a variety of methods have been used to this purpose: the so-called Q-tip test, radiologic techniques and ultrasonic studies. Transvaginal and perineal ultrasonography allows the assessment of bladder neck and urethral axis mobility at rest, during cough, Valsalva maneuvre and pelvic floor contraction. The technique is simple, not invasive and without discomfort for the patients. Aim of this study is to assess the reproducibility of an ultrasonic technique that allows the measurement of bladder neck mobility (alpha-angle variation) and the angle of the mobile proximal tract of urethra (beta-angle). A total of 58 women were included: 23 with stress incontinence and 35 continent and asymptomatic controls. The technique allows reproducible measurement of alpha and beta angles. In stress incontinent group bladder neck mobility is significantly larger while urethral angle (beta-angle) is significantly smaller and is lowered by straining.
 ...
PMID:[Ultrasonographic assessment of urethrovesical mobility in women]. 1122 Oct 67

Color Doppler ultrasound is a new method for documenting fluid leakage in the setting of videourodynamic testing. In order to compare color Doppler ultrasound with traditional fluoroscopic imaging we performed a prospective blinded comparative clinical study. Fifty-two consecutive patients undergoing urodynamic investigations for symptoms of incontinence or prolapse were examined using fluoroscopy and translabial color Doppler ultrasound to document stress leakage. The investigators were blinded to each other's results. Both tests were performed at maximum bladder capacity and with an indwelling 5 Fr microtransducer catheter, in both the supine and the erect positions. Equivalent results for both methods were obtained in 48 out of 52 patients (Cohen's kappa = 0.82). It was therefore concluded that translabial color Doppler ultrasound imaging can reliably demonstrate leakage through the female urethra on Valsalva maneuver or coughing.
 ...
PMID:Translabial color Doppler urodynamics. 1171 95

FROM PHYSIOPATHOLOGY TO TREATMENT: Urinary incontinence on effort in women is due to a default in sub-urethral anatomical structure, which leads to incontinence on effort (coughing, laughing, carrying heavy weights, physical activity). When re-education fails, surgical treatment using Burch's technique or the placing of sub-urethral TVT (Tension free Vaginal Tape) is generally proposed. BURCH'S TECHNIQUE: Burch's technique consists in an upper tract colposuspension via coelioscopy or laparotomy, under rachis or general anaesthesia. In the literature, the following rates of complete cure have been presented: 64 to 87%, 75 to 95% and 63 to 89% respectively in the short, median and long term together with the cure of certain complications (vesicular instability, dysuria, secondary prolapse, infections). THE TVT TECHNIQUE: Developed in the early nineties, the placing of TVT is a mini-invasive technique requiring the use of polypropylene tape inserted vaginally under the urethra under rachis or local anaesthesia. It is associated with over 80% median term clinical efficacy and rare complications (vesicular perforation, arterial wounds, perineal haematoma, dysuria, infections).
 ...
PMID:[Stress urinary incontinence in women. Physiopathology and surgical treatment using Burch's technique and TVT]. 1185 Sep 91

In the last century, the pathophysiology of stress urinary incontinence (SUI) has been investigated and several surgical techniques have been utilized for cure. The most recent evolution in the study of SUI is the minimally invasive tension-free vaginal tape (TVT) procedure, which can be done under local anesthesia and intravenous sedation and is individualized for each patient. The procedure recreates the "hammock" of the anterior vaginal wall and endopelvic fascia with a mesh tape of polypropylene. The cure rates of the initial studies are equal to or better than other anti-incontinence procedures, and the permanent supportive mesh is very well tolerated. The TVT creates a backboard on which the urethra compresses itself when it rotates posteriorly during cough or stress. The procedure accomplishes subjective and objective cure without elevating the bladder neck or altering urethral mobility.
 ...
PMID:A review of the tension-free vaginal tape procedure: outcomes, complications, and theories. 1208 43

Stress urinary female incontinence (IUS) is an unpleasant symptom describing a loss of urine during physical exertion; genuine stress incontinence (GSI) is a socially unacceptable, involuntary loss of urine in absence of detrusor activity from the urethra associated with sudden cough or strain. The incidence of IUS is less than 10% in reproductive-age women but may approach 10-20% in postmenopausal women. The IUS pathophysiology is connected with two specific mechanisms: the urethral-bladder sliding out of anatomical area involves the normal system of endobladder/intraabdominal pressures, with a loss of urine; the second mechanism involves the damaged urethral sphincteric function, with a reduction of the urethral closure pressure and a urinary loss after minimal physical stimulation. The IUS medical therapy is troublesome and often inefficient, and the only approved effective measures are the surgical procedures, actually reserved for cases of unsuccessful medical therapy; surgical treatments can be classified according to the access as: vaginal, abdominal, associated and complex. They intend to reposition the urethral-bladder sliding in its normal intra-abdominal position, to allow equal transmission of increased intraabdominal pressure to the bladder and the proximal urethra. In the scientific literature there are more than one hundred surgical procedures for IUS correction, but the IUS surgical approach is anyway the actual gold standard therapy.
 ...
PMID:[Stress urinary incontinence: an overview on actual surgical trends]. 1259 40

Forty patients who underwent a single tension-free vaginal tape procedure were evaluated by perineal ultrasound both pre- and postoperatively in a prospective observational clinical study. The positions of the tape, bladder neck and urethra were sonographically documented at rest and during Valsalva maneuvers. During Valsalva the tape rotated towards the symphysis in all patients. Postoperative urethral angulation could be demonstrated in 36 of 40 patients. Bladder neck mobility remained unchanged after the tension-free vaginal tape procedure, and 36 of the 40 were dry according to patient questionnaires. Postoperative cough test was negative in all patients. Two points seem to be important for the functioning of the tension-free vaginal tape: a dynamic kinking of the urethra during stress, and the movement of the tape against the symphysis, compressing the tissue between the tape and the symphysis. Mobility of the bladder neck is unaffected by the single tension-free vaginal tape procedure.
 ...
PMID:How does tension-free vaginal tape correct stress incontinence? investigation by perineal ultrasound. 1467

This study forwards a new surgical approach we have performed in the treatment of genital prolapse, associated or not with stress urinary incontinence. The study used 150 patients with genital prolapse and stress urinary incontinence in various stages, and lasted from 1985 until 2001. Four-five threads of silk were passed through the uterine muscle in the isthmus area, just below the bladder-uterus recess, and fastened to the supra-pubic ligament complex. Although the mechanical basis for this surgical approach is not entirely clear, no relapse, incident or post-surgery complications (bladder voiding problems, enteroceles, detrusor instability, urethra or bladder bottom lesions, incomplete urinary retention or clearance, hematoma or abscess of the Retzius space) were noted in any of the studied cases. The suspension of the uterine isthmus on to the supra-symphyseal fibrous complex leads to an increase in urethral closure pressure during the occasional increase of intra-abdominal pressure (cough, laughter, spontaneous movements, walking), the results being superior to the other methods used for treating genital prolapse.
 ...
PMID:The use of the supra-pubic fibrous complex in isthmic hysteropexies. 1475 75

Stress urinary incontinence (SUI) has been defined as the complaint of involuntary leakage of urine on effort, exertion, sneezing or coughing (Abrams et al, 2002). It becomes known as urodynamically proven stress incontinence (USI) when filling cystometry (a test of bladder function) shows a rise in intra-abdominal pressure, without a detrusor muscle (bladder muscle) contraction, causing urine loss via the urethra.
 ...
PMID:Current treatments for patients with stress urinary incontinence. 1476 55

Changes in structural support of the urethra and bladder neck have been proposed as important factors in the pathogenesis of stress urinary incontinence (SUI). In this context, we undertook an ultrastructural study on the periurethral connective tissue with an emphasis on incontinent women with normotonic and hypotonic urethras. Small specimens of periurethral connective tissue were obtained by dissection during a tension-free vaginal tape-implantation procedure in 34 stress urinary incontinent postmenopausal women with a normotonic urethra and 9 stress urinary incontinent postmenopausal women with a hypotonic urethra. In the samples taken from stress-incontinent women with a normotonic urethra, intact elastic fibers were closely connected with collagen fibers, smooth muscle cells and fibrocytes. In the samples taken from stress-incontinent women with a hypotonic urethra, we detected irregular fragmented distribution of the elastin within the tissue. We assume that these structural changes lead to functional consequences, such as diminished tissue extensibility and loss of stability surrounding the female urethra. These altered connective tissue properties may affect the mechanism of urethral closure under stress (e.g., coughing) and therefore contribute to the occurrence of SUI with a hypotonic urethra.
 ...
PMID:Changes in the extracellular matrix in periurethral tissue of women with stress urinary incontinence. 1696 46

Treatment options for stress urinary incontinence (SUI) in women are designed to prevent the involuntary loss of urine from the urethra during increases in intraabdominal pressure that occur during physical activity, coughing, or sneezing. Effective nonsurgical therapies include behavioral therapy (eg, bladder training, fluid and dietary modification) and drug therapy. Surgical therapy for this condition has existed for well over 100 years. Currently, approximately 200 different surgical procedures have been described. Because of the physiologic risks inherent in surgical procedures, the cost of hospitalization, and the loss of productivity during convalescence, surgeons continue to modify their techniques to improve efficacy, safety, and cost-effectiveness, and to minimize invasiveness. No single procedure or intervention is optimal for all patients. Having a variety of treatment options offers the possibility of tailoring therapy to the desires and needs of the individual patient. The key to an optimal therapeutic outcome is an accurate diagnosis combined with the selection of an appropriate intervention that is acceptable to the patient after balancing multiple factors.
 ...
PMID:Treatment options for stress urinary incontinence. 1698 62


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>