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

In a retrospective study, 94 patients were examined after incontinence operation. We show the anamnestic, clinical and urodynamic results. Standardised questions were used for exploring the patients' history. The loss of urine during provocation, like coughing with a filled bladder up to 300 ml, showed the clinical incontinence. The urodynamic investigations were performed with a modern, computer-guided instrument. The pressure was measured by highly flexible polyurethane catheters with micro-tip pressure transducers. The examinations were made in horizontal position with 100 ml, and upright position with either 100 ml or 300 ml bladder volume. Approx. 50% of the examined patients had postoperative stress incontinence both anamnestically and urodynamically. After vaginal repair and the Marshall-Marchetti-Krantz procedure, regardless of maximal urethral closure pressure (UVDR max), the recurrence rate was doubled in comparison to Burch colposuspension. After dividing all patients into those with hypotonic and those with normotonic urethra, the recurrence rate was doubled when UVDR max was low. The comparison of vaginal repair and abdominal colposuspension in patients with hypotonic urethra showed a significantly higher recurrence rate in the first group. In a preliminary prospective study, 19 patients with hypotonic urethra prior to surgery underwent Burch colposuspension. The examinations 3-6 months later did not show any stress incontinence. The main UVDR max ascended from 28.2 to 38.2 cm H2O. The increase was statistically significant (p less than 0.003). Unsatisfactory results after incontinence operations were obtained on patients with vaginal repair with hypotonic urethra. Preliminary results show, that after Burch colposuspension on patients with low maximal urethra closure pressure, a reduction of recurrence may be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Recurrence rate following surgery of incontinence in patients with hypotonic urethra]. 258 29

To evaluate urodynamic effects of modified Burch colposuspension, 24 patients with stress urinary incontinence were investigated before and 6 to 9 months after the operation. A new method of urodynamic evaluation was performed using a multitransducer-catheter, 5 microtransducers inside the urethra and 1 in the bladder, connected to a computer and graphic plotter. Single coughs were analysed with the catheter in a fixed position and the patient in the standing position. The operation, which was successful, in all but 1 patient, did not alter urethral pressure at rest, but urethral closure pressure at stress after the operation (mean 45.0 cm H2O (SD 21.6) was significantly higher (P less than 0.005) than the -3.6 cm H2O (SD 10.2) recorded before the operation. The pressure transmission ratio was less than 100% in 22 patients before the operation and more than 100% in 18 patients afterwards, the pre- and post-operative mean values being 78.9% (SD 11.9) and 109.5% (SD 17.2) respectively (P less than 0.0005). Burch colposuspension markedly improves urethral closure function as evaluated by this method, which analyses the pressure data at different points of the urethra and bladder during one single cough.
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PMID:Effect of suprapubic operation on urethral closure. Evaluation by single cough urethrocystometry. 271 20

Twenty-nine consecutive patients with stress urinary incontinence were investigated by bead chain urethrocystography (UCG) and single cough urethrocystometry before operation and 8-12 months after a Burch colposuspension producing clinical improvement. The operation significantly elevated the bladder neck and reduced its mobility during acute stress. The urethral inclination angle and the posterior urethrovesical angle also became smaller at rest and on straining. A significant negative correlation was found between the postoperative mobility of the bladder neck and the post-operative pressure transmission ratio (PTR), indicating that correction of the urethrovesical anatomical disorder eliminates the functional disorder in this disease and restores continence.
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PMID:Successful colposuspension in stress urinary incontinence reduces bladder neck mobility and increases pressure transmission to the urethra. 278 51

Urethrocystography and simultaneous urethrocystometry were performed on 40 women with primary urinary incontinence. The posterior urethrovesical angle, inclination angle, urethropelvic angle, and an orifice descent angle, not earlier described, were measured on radiographs obtained at rest, during coughing and during straining. The orifice descent angle was used to describe the descent of the internal urethral orifice in the cough radiographs, and was the only measurement that provided a significant correlation with urethrocystometry. The other angles measured, and radiographs obtained at rest or during straining were not useful in the evaluation of female stress urinary incontinence. The authors conclude that the best imaging method for the evaluation of female stress urinary incontinence is urethrocystography employing a single lateral view taken during coughing, with measurement of the orifice descent angle.
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PMID:Cough urethrocystography: the best radiological evaluation of female stress urinary incontinence? 280 75

A new instrument consisting of a six-transducer catheter, one transducer for the bladder and five transducers for urethral pressure recordings, and a computer with specific software was developed for urodynamic investigation of women. Twenty-six patients with stress urinary incontinence (SUI) and 10 continent female patients were evaluated during the single cough, the first and the fourth ones of the forced coughings in supine and standing positions. The results were compared with those obtained with the conventional two-transducer method. Negative urethral closure pressure (UCP) at stress, indicative of SUI, was present in 88 percent of the cases with the six-transducer method, and in 77 percent with the two-transducer method. The fourth cough in the standing position with the six-transducer method was most diagnostic. In SUI, the six-transducer method indicated exactly, e.g., the minimum bladder pressure needed for negative UCP and the duration of negative UCP. Patients with SUI had significantly lower UCP at rest, UCP at stress, and pressure transmission ratio (PTR) than continent women. Findings, that UCP at stress decreased and duration of negative UCP at stress increased but PTR did not change when the fourth cough was compared with the first one in SUI, suggest that factors which are responsible for the altered urodynamics during prolonged stress are anatomic rather than functional.
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PMID:Six-microtransducer catheter connected to computer in evaluation of urethral closure function of women. 291 92

Transabdominal urethrocystopexy by using a two-component fibrin sealant as a substitute for sutures was performed in 99 women suffering from proved urinary stress incontinence. All were assessed preoperatively, both clinically and by urodynamic tests. This report deals with the results after a follow-up period not shorter than 1 year and up to 4 years. We found it essential not to report postoperative results concerning observation periods shorter than 1 year, as most relapses are observed more than 1 year after operation. Success was defined as absence of objective urine loss at coughing or straining with full bladder in upright position. The results imply that this simple technique is worthy of trial in correcting urinary stress incontinence in women.
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PMID:Retropubic urethrocystopexy with fibrin sealant: a long-term follow-up. 324 Aug 94

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

The changes in urethral pressure that occur during a cough, and microtransducer measurements of urethral pressures at rest, suggest that structures extrinsic to the urethra and vesical neck influence sphincteric function. The present study examined the structure of the extrinsic continence mechanism as it relates to these physiologic observations. Serial histologic sections of the pelvic viscera made from eight female cadavers and dissections of 34 cadavers were examined. In the proximal urethra, the anterior vaginal wall is attached to the muscles of the pelvic diaphragm and to the arcus tendineus fasciae pelvis. Contraction of the pelvic diaphragm would pull the vagina against the posterior surface of the urethra, causing an increase in posteriorly measured "pressures." Support of the urethra at rest comes from both its attachment to the arcus tendineus fasciae pelvis and the resting tone of the pelvic diaphragm muscles. Two arches of striated muscle (compressor urethrae and urethrovaginal sphincter) run over the distal urethra in the region of the perineal membrane (ie, urogenital diaphragm). Activity of these muscles could compress the urethra distally, causing the urethral pressure rise that precedes and exceeds the rise in abdominal pressure during a cough and explaining asymmetry of pressure measurements in this area. Recognition of these structural relationships can help us understand urethral pressures during a cough and directional "pressure" variations seen in patients with stress incontinence. They may also contribute to the understanding of surgical failures that occur despite successful urethral suspension.
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PMID:Structural aspects of the extrinsic continence mechanism. 340 47

Cough-pressure spike differences between the urethra and bladder were compared before and after surgery that cured genuine stress incontinence in 267 women. In 97.4% of 151 patients cured by a fascia lata sling procedure, the urethralvesical cough-pressure transmission ratio was greater than 100%, and in no case was it less than 100%. In 46.6% of 116 patients cured by anterior colporrhaphy, the cough-pressure transmission ratio was greater than 100%, and in 20.7% of the 116 patients, the transmission ratio was less than 100%. The 24 women in the latter group were cured by a sufficient increase in resting intraurethral pressure (to augment the maximal intraurethral closure pressure with stress) to maintain continence with increased intra-abdominal pressure. We believe that urethral kinking at the instant of increased intra-abdominal pressure with stress produced the greater than 100% cough-pressure transmission ratio seen in 201 (75.3%) of the 267 patients cured of genuine stress incontinence.
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PMID:Intraurethral-intravesical cough-pressure spike differences in 267 patients surgically cured of genuine stress incontinence of urine. 340 48

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


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