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

The vesicourethral junction, the urethra cannot be seen when using the abdominal approach because of the interposition of the pubic symphysis. The ultrasonic vaginal approach makes it possible. 53 patients were ultrasonically observed during an urodynamic exploration. The simultaneous utilization of both methods has permit to observe the mechanisms of normal or pathological voiding. When initiating a voluntary micturition, an area (called "prepubic muscle") located in front of the pubic symphysis between the clitoris and the urethral meatus, exert a traction on the periurethral sphincteric area. This sphincteric area, which is well shown by ultrasound, contracts longitudinally (causing shortening of the urethra and opening of the bladder neck) and causes a drop in urethral closure pressure. The increase in the distance between the inferior part of the pubic symphysis and the anterior vaginal wall comes about because of slackening of the elevator ani muscles. This slackening occurs at different times before the bladder contracts. The urethra opens; the complete course of this organ is well defined. Things return to their previous state when voiding finishes. In the case of stress incontinence, the lack of transmission of pressure urodynamically found when the woman is coughing can be seen as a sliding mechanism within the space of Retzius and at the urethro-vesical junction behind the symphysis pubis. The degree of sliding depends on the strength of the cough. In all cases of pure stress incontinence without there being low urethral closure pressure, a maximum stress caused by coughing will produce more than 5 MM sliding before the urethra opens. If the urinary incontinence is due to low urethral closure pressure, the urethra opens without sliding of the urethro-vesical junction whenever the abdominal pressure increases. Urethral instability resembles voluntary voiding but without any voluntary command. "Prepubic" contractions, longitudinal contractions in the sphincteric area and slackening of the levator ani muscles, alone or in association, explain why urethral closure pressure drops. Sometimes this drop is followed by an increase in bladder pressure.
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PMID:[A new approach to urinary continence disorders in women: urodynamic ultrasonic examination by the vaginal route]. 333 Jan 2

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

Fifty-five of 71 women with stress, motor urge and mixed stress and motor urge urinary incontinence were treated successfully with a new integrated electrostimulation device (Incontan) used anally. Changes in urodynamic measurements were evaluated when the patients themselves reported cure or significant improvement. The duration of the treatment was 9 to 20 h/day for at least 2 months (mean 9 months). According to the patients' subjective evaluation, 71% were cured of their incontinence and 29% were markedly improved. In motor urge and mixed incontinence a significant increase in bladder volume at first sensation and at maximum cystometric capacity was found, and 45% of these patients had a normal, stable bladder after treatment. A significant increase in functional urethral length was observed in patients who had had stress incontinence, but the measured increase in maximum urethral pressure was not significant. Of the 16 patients with stress and mixed incontinence who reported cure, 15 had a positive urethral closure pressure during coughing after treatment. Urodynamic analysis confirmed the positive clinical effect observed after electrostimulation therapy. It is recommended as primary therapy in stress, motor urge and mixed stress and motor urge incontinence in women.
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PMID:Changes in urodynamic measurements after successful anal electrostimulation in female urinary incontinence. 349 25

The urological status of 133 women undergoing non-urological surgery was investigated. 16 (12%) revealed stress urinary incontinence requiring treatment, in 10 (8%) stress urinary incontinence was corrected surgically earlier on, 7 (5%) suffered from UTI. The urological status of the remaining 100 women was compared to that of 200 women who underwent surgery for stress urinary incontinence investigated in a previous study. In both groups there were no significant differences in weight, coughing and hard work which are thought to be related to the origin of stress urinary incontinence. However in the urological group trauma by multiple child bearing was significant more common as well as a pathological micturition symptomatology. 33 of the surgical women occasionally observed minimal wetting without needing treatment. This disturbance might be called "stress urinary incontinence degree 0" because it cannot be placed in the classification according to Ingelman-Sundberg.
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PMID:[Comparison of the incidence and causes of micturition disorders in surgical and stress incontinent patients]. 372 17

Uninhibited urethral relaxation appears to be a clinically distinct cause of urinary incontinence. It was found in 11 of 534 incontinent women who had multichannel urodynamic evaluation, and in 2 of these it was the sole cause of incontinence. This diagnosis should only be made after careful scrutiny has ruled out a low pressure detrusor contraction, cough, valsalva, or heel bounce as the cause of the urethral relaxation. Because the majority of patients had a voiding mechanism that included a detrusor contraction, it is unlikely that uninhibited urethral relaxation represents a variant of detrusor instability in patients unable to generate a detrusor contraction. It most likely reflects an exaggeration of urethral instability due to relaxation of the smooth and/or striated urethral musculature.
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PMID:Uninhibited urethral relaxation: an unusual cause of incontinence. 376 77

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

The value of cystometry in the diagnosis of recurrent urinary incontinence is to differentiate between urge and stress incontinence. This is possible through determination of detrusor hyperactivity characterized by uninhibited detrusor contractions. Cystometry is necessary since neither history nor clinical examination can differentiate between urge and stress incontinence. Both types of incontinence are in many patients found together and factors causing stress incontinence, for instance coughing, may also cause spontaneous, uninhibited detrusor contractions. The diagnosis of detrusor hypoactivity is also important although lack of detrusor contractions is not identical to lack of contractility. In only 50% of patients are detrusor contractions present following correction of the urinary incontinence and increase of urethral resistance. In the other half of the patients, lack of detrusor contractility remains. There is evidence that a so-called micturition-stop-test may allow a prognosis in cases of lack of bladder contractility. Cystometry is, therefore, a conditio sine qua non although it only gives information concerning the function of the detrusor. Concerning the evaluation of the bladder outlet, additional radiological and urodynamic examinations are necessary.
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PMID:[Recurrent urinary incontinence: cystomanometry--conditio sine qua non?]. 378 89

Thirty-one female patients were investigated 4.8 +/- 2.5 years after pubococcygeal repair for stress urinary incontinence (SUI). Eighteen patients had a successful operation with total cure or marked improvement and 13 had a failed operation. The results of the operation were further evaluated clinically by detailed patient history and urodynamically by urethrocystometry (UCM). The severity of the SUI symptoms was evaluated by recording the physical stress causing incontinence, restrictions of daily activities and social life and use of protective pads. The symptoms were graded by the SUI score ranging from 0 to 10. The bladder pressure rise necessary for urinary leakage during coughing (The SUI threshold) was measured by UCM. The mean SUI score was 2.2 +/- 1.0 and 6.9 +/- 4.8 after successful and failed operations, respectively and the SUI threshold was 85 cm H2O and 57.5 cm H2O after successful and failed operations, respectively. The SUI threshold had a significant negative correlation with the SUI score. It is suggested that the SUI threshold is a valuable addition to UCM determining objectively the results of incontinence surgery. It should be measured each time an UCM is performed.
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PMID:Quantification of urethral closure function by SUI threshold after pubococcygeal sling operation. 386 25

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

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


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