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

Urodynamic examinations carried out on 45 patients with stress urinary incontinence (SUI) and 17 women without a history of incontinence using simultaneous microtransducer urethrocystometry were examined in order to develop an objective indicator of the severity of the condition. Five urethral pressure profiles (UPP) with stress were recorded, maintaining a constant coughing strength as seen in the bladder pressure rises. The coughing strength was increased stepwise for successive profiles. Zero urethral closure pressure, indicating genuine SUI, appeared with bladder pressure rises of less than 50, 75 and 100 mm Hg and of 100 mm Hg or more in 7, 27, 45 and 67% of the 45 symptomatic patients, respectively. 33% had a positive closure pressure in every UPP. 2 women without symptomatic incontinence had negative urethral closure pressures. The lowest bladder pressure rise needed for zero urethral closure pressure showed a significant negative correlation with the clinical grade of SUI and the degrees of social restriction experienced. We suggest that SUI can be classified urodynamically into minimal (lowest bladder pressure rise producing zero urethral closure pressure 100 mm Hg or more), mild (75-99 mm Hg), moderate (50-74 mm Hg) and severe forms (less than 50 mm Hg).
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PMID:Degree of female stress urinary incontinence: an objective classification by simultaneous urethrocystometry. 654 Nov 76

The value of the urethral stress profile after surgery for urinary stress incontinence in females was prospectively analyzed using microtransducers. 95 patients were clinically and urodynamically assessed at least 6 months after surgery. The success of the operation was based on subjective (patient's history) and objective (no urine loss, erect, with full bladder, on coughing and during a Urilos nappy test) criteria. In 20% of the cases, the interpretation of the urethral profiles did not correlate with the clinical objective criteria. Possible explanations for this discrepancy are discussed.
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PMID:Clinical relevance of urethral stress profile using microtransducers after surgery for stress incontinence in females. 668 62

A comparative study was made regarding the complications of abdominal and vaginal sterilization operations in order to evaluate the efficacy and safety of the 2 procedures. The cases were selected from outpatient departments and family planning clinics of the Patna Medical College (Patna, India) over the 1974-79 period. A preoperative assessment and investigation were performed in all cases. The operations were performed by modified Pomeroy's technique in 300 cases (Group A) by abdominal route and in 300 cases (Group B) by vaginal route. General anesthesia was administered in all cases. Subsequent follow-up was done at intervals of 6 weeks, 3 months, 6 months, 1 year, and up to 5 years. Follow-up attendance was unsatisfactory, but a comparative evaluation of the complications was done in both groups among patients who came for follow-up. Puerperal sterilization cases were excluded from the series. In Group A 149 sterilizations were done with medical termination of pregnancy (MTP) and the remaining were interval sterilizations. In Group B 148 were sterilizations with MTP and the remaining were interval sterilizations. The age varied between 28-42 years. The majority of the patients were more than 4 para in both groups. Pelvic sepsis was more common with vaginal sterilization operations. Complications were as follows in Group A: pyrexia, 30 cases; pain in abdomen, 75; urinary tract infection, 30; sore throat, cough, 60; stitch induration, 90; and wound disruption, 3. For Group B, complications were as follows: pyrexia, 90; pain in abdomen, 30; urinary tract infection, 75; sore throat, cough, 60; tuboovarian mass, 12; wound infection, 45; and persistent temperature rise, 12. The nature of complaints at follow-up for Group A were: leukorrhea, 30; menorrhagia, 60; irregular bleeding, 30; dysmenorrhea, 12; dyspareunia, 9; loss of libido, 9; and incisional hernia, 1. Complaints at follow-up were as follows for Group B: leukorrhea, 45; menorrhagia, 21; irregular bleeding, 60; dysmenorrhea, 75; dyspareunia, 60; loss of libido, 12; abdominal pain, 12; and stress incontinence, 3. In sum, the sterilization operation by abdominal route was much safer compared to the vaginal route.
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PMID:Complications after abdominal and vaginal sterilization operation. 687 69

Simultaneous urethrocystometry by means of a dual microtransducer catheter was performed according to a precise, standardized technique serially at 8, 16, 28, and 36 weeks of pregnancy and at 8 weeks post partum in 43 healthy nulliparous women. The urethral pressure profile at rest and the effect of stress (cough) on the urethral pressure profile during pregnancy and after delivery were measured. At each recording session, blood was obtained for determination of 17 beta-estradiol (E2), progesterone (P), and 17-alpha-hydroxyprogesterone (17-OH-PO). The continence parameters functional urethral length and urethral closure pressure, as well as the urethral closure pressure response to stress, did not change systematically during the course of pregnancy. Engagement of the presenting part at 36 weeks did not influence the urethral pressure profile measurements. Alterations in hormone levels during pregnancy were not correlated with the changes in urethral pressure profile measurements. Both urethral pressure and length parameters in all women who underwent vaginal delivery were notably decreased 8 weeks post partum when compared with early pregnancy values and with values obtained in a group of healthy nulliparous women in the follicular phase of the cycle. The decrease in length parameters was not observed in the six women in whom delivery was by cesarean section. The postpartum changes were not significantly correlated with the duration of the second stage of labor or with the presence or absence of an episiotomy. Also, no relationship with infant birth weight was found. Values of the urethral pressure profile parameters below the median value and defective transmission of pressure over the urethra were observed in almost all women who experienced stress incontinence during pregnancy and/or after delivery. These observations suggest that an inherent weakness of the urethral sphincter mechanism plays a key role in the pathogenesis of stress incontinence.
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PMID:The urethral pressure profile in pregnancy and after delivery in healthy nulliparous women. 689 Mar 13

Characteristic alterations of urethral pressure and length occur in patients with stress urinary incontinence. Urodynamics in this group of 50 patients revealed a significant decrease in urethral functional length under the stress of bladder filling and change of position from supine to sitting. A decrease in urethral closure pressure was present in individual patients and was significant. All patients with stress urinary incontinence demonstrated a decreased ability to voluntarily increase urethral pressure and also had evidence of pressure equalization on Valsalva maneuver and coughing. Cough pressure profiles also demonstrated equalization of urethral and bladder pressures. These profiles also were performed in a subgroup of 12 patients with genuine stress incontinence after treatment of incontinence by retropubic urethropexy. These profiles became normal after surgery and correlated with the clinical cure of stress urinary incontinence.
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PMID:Urodynamics in women with stress urinary incontinence. 689 Jun 57

From a questionnaire survey dealing with urinary incontinence during pregnancy and after childbirth 62 women were randomly selected. These women underwent simultaneous urethrocystometry including urethral profile measurement 7--14 days after parturition. From the case history two groups of patients could be distinguished. One group consisted of women who experienced only occasionally urine leakage after delivery. Pressure recordings in these previous patients were normal, moreover the urethral closure pressure was positive, also at cough provocations. The urethral length and pressure were similar to that found in continent females. The other group of patients reported stress incontinence of a more serious and permanent nature; the symptoms did not disappear after delivery. In all these women negative urethral closure pressures were recorded at cough provocations and simultaneously leakage of urine from the urethra was observed. In addition the urethral length was shorter and urethral resting pressure lower than that recorded in the first group of patients. The reversible symptoms in the first group of women may be a consequence of the pressure exerted by the uterus upon the bladder at coughing combined with a hormonal relaxation of the urethral suspension. In the second group, the enduring symptoms suggest irreversible damage to the urethra and its suspension system during pregnancy.
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PMID:Postpartum incontinence. 719 4

The fluid-bridge test (FBT) detects the entry of urine into the proximal urethra during coughing. In this study it was applied in the investigation of incontinent patients when they were first supine and then standing up. The test results in 76 women with urinary incontinence and 27 women with normal urinary control are reported. When the test was performed erect at 0.5 cm from the urethrovesical junction, it was positive in 68 (90%) of the study group and 4 (15%) of the controls. The difference between the results in the 2 groups is highly significant (P less than 0.001). In 12 (16%) of the incontinent group the test at 0.5 cm became positive only when the subject was standing up, indicating that erect testing adds to the diagnostic efficiency of the method. Erect testing seems more relevant to the investigation of stress urinary incontinence. This study has shown that this is possible using simple urodynamic apparatus.
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PMID:Detection of urethral incompetence. Erect studies using the fluid-bridge test. 719 73

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

Colpo-cysto-urethrography, urodynamic and cystometric examinations were performed in 420 patients from the departments of urology and gynecology. One hundred and ninty-eight patients displayed displacement of the urethro-vesical junction in the anterior and inferior direction. Three grades of displacement were established. The mildest form, grade 1, was visible only during a cough. The intermediate form, grade 2, was present even at rest. The severest form, grade 3, involved a displacement of the anterior vaginal wall, resulting in anterior bladder descent during cough and/or micturition. Stress incontinence was a complaint in 82 per cent of the women. The pathology is shown to be laxity of the arcus tendineus fasciae pelvis, which normally exerts a pull on the bladder neck in a postero-cranial direction. In seven cases anatomically corrective operations on this ligament were performed, resulting in a normal bladder base in an anatomically correct position. The operation is complicated and not suited for routine use.
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PMID:Anterior bladder suspension defects in the female. Radiological classification with urodynamic evaluation. Anatomically corrective operations. 745 98


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