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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reference is made to the relevance of urethral pressure profile and its parameters, on the basis of urethrocystometric checks of 34 control patients and of another 44 women who had had to undergo surgery for urinary incontinence. In cases of urinary stress incontinence, values prior to surgical treatment generally were lower, but some of the parameters were (statistically insignificantly) enhanced by the operation. - The conclusion is that the urethral pressure profile at rest and under stress (with coughing provoked) provides a more consistent indication of surgery. Yet, accurate diagnosis is not possible on the basis of such examination alone.
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PMID:[Relevance of urethral pressure profile to diagnosis of stress incontinence (author's transl)]. 720 Mar 9

The key to restoring urinary continence in the female is to raise the internal vesical neck of the bladder to a position behind the symphysis pubis. The operation which accomplishes this with the least morbidity, the most accuracy and the greatest permanency is endoscopic suspension; it is particularly applicable in patients with obesity, multiple operative failures, radiation incontinence, and severe pelvic fractures. Between December 1973 and May 1979, 203 patients underwent 211 operations with a minimum of six months of follow-up study at final review (November 1979). Twenty per cent of the patients were totally incontinent on referral, and 60 per cent lost urine with minimal activity; only 20 per cent of the patients had typical stress urinary incontinence, requiring coughing or sneezing to lose urine. Among the 203 patients, there were 188 previous operations for urinary incontinence, including 74 Marshall-Marchetti retropubic repairs. Forty-seven patients have been followed for over four years, and 156 patients have been followed for six months to four years. While 138 patients had a previous hysterectomy, 65 patients had not; the presence of the uterus did not affect the results. Urinary incontinence is not an indication for hysterectomy. Ninety-one per cent of the 203 patients were cured of their urinary incontinence by endoscopic suspension of the vesical neck. Technical advantages over the retropubic vesical neck suspensions include the use of monofilament heavy nylon (No. 2), a vaginally placed Dacron((R)) buttress to prevent tearing of the pubocervical fascia, less postoperative morbidity, minimal blood loss, functional measurements and anatomic visualization of a restored vesical neck during the operative procedure, easy access to a surgically difficult pelvis, and simultaneous repair of significant rectoceles or substantial cystoceles through the same operative field.
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PMID:Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. 742 93

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 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

In patients with incontinence problems, endovaginal urodynamic ultrasonography is a technique which easily complements manometric examination by permitting a precise study of peri-urethral soft tissue. Use of a linear array probe under standardised conditions gives, at present, the best results. To validate the technique, it is, however, important to understand the artefacts it provokes. Thirty-four patients underwent urethral profilometry at rest and during effort with and without the ultrasonographic probe. In the patients studied, none of the classical urodynamic parameters were modified. However, in cases of narrow vaginas (distance between the arcuate ligament and the ultrasonographic probe less than 12 mm), a small increase in the maximum urethral closure pressure (5 cm H2O) could be observed. The angle between an intra-urethral cotton swab and the horizontal plane was measured at rest and during maximum coughing effort, both with and without the ultrasonographic probe. A significant reduction of the angle was observed at rest and during effort. However, since linear regression is particularly effective in modelling these two artefacts (R2 = 0.8 and 0.7), they can be considered as constants and are not bothersome in clinical practice. Abdominal ultrasound was used in 10 patients during the introduction of the endovaginal ultrasonographic probe to study its impact on the base of the bladder. A clear increase in the posterior urethro-vesical angle was observed, which was shown to be a function of the degree of probe insertion in the vagina. As this artefact was variable and could not be controlled, this angle should no longer be measured using this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Study of the artefacts induced by linear array transvaginal ultrasound scanning in urodynamics. 788 71

Forty-six patients were evaluated for complaints of urinary incontinence or voiding disorders. Diagnostic testing included a detailed history, physical examination, urine analysis, and urodynamic studies consisting of a conventional urodynamic test (S.I.) including provocative manoeuvres and extramural ambulatory urodynamic monitoring (e.a.m.). We compared the pre-classification diagnoses obtained from the medical history with both urodynamic tests. Conventional cystometry detected detrusor instability in 8 patients out of 16 with a history of urgency, while a normal detrusor behaviour was observed in the other 8. "Provocative" manoeuvres yielded an additional 13.3%. Extramural ambulatory monitoring confirmed the diagnosis in the 8 patients with hyperactivity and revealed detrusor instability in a further 7. E.a.m. proved adequate in 93.7% of patients with symptoms of detrusor instability. In the group of patients with urinary stress incontinence (USI) e.a.m. revealed detrusor instability in 18.7% of the patients, but did not significantly improved the diagnostic results obtained by S.I. Coughing was the most effective stimulus to objectify stress incontinence. The comparison of the results obtained with S.I. and those obtained with home e.a.m. will probably lead to a more rational use of both methods. Our data confirm the promising impact of ambulatory urodynamic investigation.
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PMID:Standard and extramural ambulatory urodynamic investigation for the diagnosis of detrusor instability-correlated incontinence and micturition disorders. 792 Jun 80

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

Rises in intra-abdominal pressure are common and are accompanied by reflex contraction of the external sphincter. Voluntary contraction of the sphincter is an uncommon event but is routinely used as a measure of sphincter strength. Cough pressure and squeeze pressure were compared in 75 patients using a 4 channel perfused catheter (3 anal and 1 rectal side-hole). Maximum anal cough pressure was higher than squeeze pressure (mean 158 vs 133 cm H2O, P = 0.0015). Intra-individual variance was less using cough pressure (mean 20% vs 29%, P = 0.005). There was significant overall correlation between cough pressure and squeeze pressure (P < 0.001) although in some cases there were wide differences, suggesting that use of both cough and squeeze pressure in manometry will assess sphincter strength more reliably. Measurement of the recto-anal pressure gradient during coughing correlated significantly better with degree of incontinence than cough or squeeze pressure (P = 0.005). The presence of a positive gradient was 100% specific for incontinence but the sensitivity was only 43% suggesting that factors other than simple mechanical sphincter weakness are involved in incontinence. Measurement of cough pressure has both clinical and research importance and should be added to standard manometric protocols.
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PMID:The cough response of the anal sphincter. 816 97

In this study, a follow-up examination was carried out, comprising 59 female patients who were operated between the years 1985 and 1991 because of recurrent urinary incontinence. We distinguished two different operating methods: 34 women were treated following the Marshall-Marchetti-Krantz operation technique, whereas a fasciaplasty-suspension was employed om 25 patients. At the urodynamic follow-up examination, the patients had experienced an average history of 2 years' recurrent urinary incontinence. The patients' subjective observation of anamnestic urinary incontinence was objectified by a clinical cough test, cystotonometry and sonography of the small pelvis. Making extensive use of the urodynamic examination possibilities showed a 79.4% improvement following the Marshall-Marchetti-Krantz operation in comparison to a 52% improvement after the fasciaplasty operation. The operations success is assessed by evaluation of the depression quotient. Here the Marshall-Marchetti-Krantz operation resulted in a significant improvement. After the fasciaplasty operation, however, this was not found to be the case.
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PMID:[Marshall-Marchetti-Krantz operation or fasciaplasty in therapy of recurrent urinary incontinence in women]. 822 23

To estimate the probabilities of complications and follow-up treatment, a sample of Medicare patients who underwent radical prostatectomy (1988 through 1990) was surveyed by mail, telephone, and personal interview. Respondents reported their current status with respect to continence and sexual function as well as post-surgical treatments they had had to treat residual or recurrent cancer or surgical complications. Over 30 percent reported currently wearing pads or clamps to deal with wetness; over 40 percent said they drip urine when they cough or when their bladders are full; 23 percent reported daily wetting of more than a few drops. About 60 percent of patients reported having no full or partial erections since their surgery, and only 11 percent had any erections sufficient for intercourse during the month prior to the survey. Six percent had surgery after the radical prostatectomy to treat incontinence; 15 percent had treatments or used devices to help with sexual function; 20 percent report having had post-surgical treatment for urethral strictures. In addition 16 percent, 22 percent, and 28 percent reported follow-up treatment for cancer (radiation or androgen deprivation therapy) at two, three, and four years after radical prostatectomy. These estimates of complication and follow-up treatment rates are generally higher, and almost certainly more representative for older men, than estimates previously published. Patients and physicians may want to weight heavily the complications and need for follow-up treatments when considering radical prostatectomy for prostate cancer.
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PMID:Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993). 825 94


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