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

Ultrasound is a complementary evaluation for the study of female urinary incontinence which allows functional-morphological documentation. With sonography dynamic images during coughing, Valsalva, pelvic floor contraction and micturition are provided. Ultrasonography of the urethrovesical anatomy improves our thinking of function and anatomy and will therefore have an important place in the diagnosis and treatment of urogynecologic disorders.
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PMID:The clinical value of sonographic imaging of the urethrovesical anatomy. 1140 19

The requirements for reliable urodynamics are standardized techniques, including uniform pressure sensors, filling rates, position and posture during the investigation, and uniform diuresis. Physiological variations in flow and urethral pressure profile (UPP) (menstrual cycle, intensity of coughing, circadian variations) must be considered. Parameters of the UPP (maximum (closure) urethral pressure, pressure-transmission ratio and leak-point pressure) are useful if interpreted with caution. Uninhibited detrusor contractions are more frequently recorded in ambulatory urodynamics, and range from 'subthreshold' to very strong. No quantification formulae correlate with subjective symptoms or degree of urge (incontinence). Mixed incontinence can make the results of surgery worse, but do not so necessarily. Postoperative dysuria cannot be predicted from urodynamics, as surgical factors are more important. Electromyography is not useful in non-neurogenic female incontinence. For routine nonneurogenic incontinence extensive urodynamic testing can be reduced to one pressure measurement; more complicated cases must be tested by a physician with large practical experience and a theoretical background.
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PMID:A critical view on the value of urodynamics in non-neurogenic incontinence in women. 1148 47

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.
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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).
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PMID:[Stress urinary incontinence in women. Physiopathology and surgical treatment using Burch's technique and TVT]. 1185 Sep 91

Clinical assessment of stress and urge incontinence in women is always necessary before making therapeutic decisions. During the full bladder examination stress incontinence triggered by cough may suggest cervicourethral hypermobility. Leakage during the Vasalva manoeuvre may reveal incontinence due to intrinsic sphincter deficiency. The pad test provides an objective quantitative measurement of the degree of incontinence. Symptom scores enable intra- and inter-individual comparisons. Psychosocial implications are studied with specific quality-of-life scales. Together, these tests improved therapeutic strategies for managing stress and urge incontinence, providing an objective evaluation of the different treatments and thus a better medico-economic approach to the problem.
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PMID:[Clinical evaluation of urinary incontinence in the woman]. 1191 24

The aim of this study was to determine the quantitative and qualitative effects of patient position on coughing and Valsalva leak-point pressure in women with genunie stress incontinence. Thirty-seven patients with genuine stress incontinence and 4 with mixed incontinence underwent multichannel urodynamics using a standardized protocol. Leak-point pressures were performed using 8 Fr microtip catheters placed in the bladder and vagina at a bladder volume of 250 ml in the supine, semirecumbent and standing positions. Urethral pressure profilometry was performed in the semirecumbent position at a bladder volume of 250 ml. The mean (range) age, and median (range) gravidity, parity, body mass index (BMI), and mean (range) Q-tip deflection angle were 61 years (36-80), 3 (1-8), 3 (1-6), 26 (22-30) and 55.8 degrees (25 degrees-80 degrees), respectively. The mean (+/- standard deviation) Valsalva leak-point pressures in the supine, semirecumbent and standing positions were 82 +/- 23, 73 +/- 24 and 63 +/- 22 cmH2O, respectively (P<0.001). The mean (+/- standard deviation) cough leak-point pressures also decreased as the patients were moved from the supine (98 +/- 29 cmH2O) to the semirecumbent (88 +/- 24 cmH2O) and standing positions (77 +/- 24 cmH2O) (P<0.001). The correlation between leak-point pressure and maximum urethral closure pressure was statistically significant and was dependent upon patient position and the provocative maneuver used.
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PMID:The effect of patient position on leak-point pressure measurements in women with genuine stress incontinence. 1199 13

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.
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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.
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PMID:[Stress urinary incontinence: an overview on actual surgical trends]. 1259 40

This retrospective descriptive study was performed to assess the practice of using the distal urethral electrical conductance (DUEC) test to objectively demonstrate urinary incontinence in symptomatic women with a negative cough stress test on examination. One hundred women had stable bladders on cystometry (CMG). Genuine stress incontinence (GSI) was diagnosed during CMG in 45 (45%). DUEC performed prior to cystometry had revealed stress incontinence in an additional 13 with negative CMG, thereby improving the diagnosis of GSI by 13%. The test detected urge incontinence in one (1%). The DUEC test improves the detection of stress incontinence. However, it should not be considered as an alternative to cystometry, but as an additional test when stress incontinence cannot be demonstrated clinically.
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PMID:Improving the diagnosis of genuine stress incontinence in symptomatic women with negative cough stress test: the Distal Urethral Electrical Conductance test (DUEC) revisited. 1260 9

Pelvic floor muscle exercises are one of the main conservative options for the treatment of female urinary incontinence. Despite this widespread use, there is very little information on 'normal' pelvic floor function. In a prospective observational study the authors intended to define the spectrum of normality for pelvic floor function in women, assessing 206 nulliparous women recruited early in their first ongoing pregnancy. Levator function was evaluated using translabial ultrasound: cranioventral displacement of the bladder neck was utilized to quantify levator activity. The presence of a reflex contraction of the external perineal muscles and levator on coughing was registered, as was the strongest of at least three contractions. Only 41 of 206 women (20%) had ever been taught pelvic floor exercises by a health professional, and this had been exclusively verbal. Teaching had no influence on levator strength. Spontaneous contractions on request were obtained in 172 women (85%). Advice was necessary in 96 women (47%) in order to obtain an optimal contraction. Reflex muscle activation on coughing was documented in 118 women (57%) and was associated with a stronger contraction (P<0.001). Reported use of the levator muscle on intercourse was strongly associated with increased levator activity (P<0.001). Motivational factors mentioned were boyfriends, mothers, other female relatives and, most commonly, articles in popular magazines, e.g. Cosmospolitan and Cleo.
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PMID:Levator function in nulliparous women. 1260 12


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