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

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 effect of bilateral pudendal blockade on the urethral pressure and power generation during coughing and pelvic floor squeezing was evaluated in 10 healthy women. The measurements were carried out at the bladder neck, in the high pressure zone, and distally in the urethra before and after blockade. Strong adjunctive closure forces were demonstrated all along the urethra. They were significantly reduced by pudendal blockade except at the bladder neck during coughing. The results indicate that the pudendal innervated striated muscles contribute significantly to the adjunctively acting closure forces all along the female urethra, including the bladder neck. Some passive pressure transmission to the bladder neck seems to take place during stress episodes following pudendal blockade, but whether it occurs in healthy females remain uncertain. The findings following pudendal blockade, corroborate with those in stress incontinent women, and thereby support the concept that striated muscle weakness is of pathophysiological significance in stress urinary incontinence.
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PMID:The effect of bilateral pudendal blockade on the adjunctive urethral closure forces in healthy females. 781 67

Pressure transmission ratios (PTR) are obtained during cough pressure profiles (delta urethral pressure/delta bladder pressure x 100) and have been extensively used in pre and post operative evaluation of patients with stress urinary incontinence. Sixteen patients with genuine stress were studied to assess the magnitude of PTR variance in incontinent women and how changes in bladder pressure impact on PTR. A marked variation in PTR was seen in individual patients with the coefficient of variation averaging 19.8%. Using linear regression analysis, 5 patients demonstrated a statistically significant relationship between bladder pressure and PTR. Only one of the five patients showed a decrease in pressure transmission with increased cough strength. The differences seen in PTR within individual patients make comparisons of single recordings at different times difficult to interpret.
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PMID:Reproducibility of pressure transmission ratios in stress incontinent women. 815 78

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

It is essential, as far as possible to be able to predict the result of perineal rehabilitation. It seems preferable to complete perineal testing by a clinical functional test for evaluation of the preventive action of voluntary perineal contraction in stress incontinence and to measure urethral pressure in four different conditions: at rest, during stress (coughing), during voluntary perineal contraction, and during both stress and voluntary perineal contraction. These tests and measures provide a better evaluation of active continence, both reflex and voluntary continence, and the ability of voluntary mechanisms to compensate for reflex mechanism during stress. It is also very important to estimate the results of perineal rehabilitation using a lot of objective and subjective tests and taking into account that only the very good results must be considered as successful. According to these criteria the authors estimate the successful results at 50% at the end of rehabilitation and only 25% in the course of the third year after the end of rehabilitation.
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PMID:[Urodynamics and perineal rehabilitation in women. Prognosis and results]. 829 66

Eighteen women who had urinary stress incontinence were studied to find the existence of urethral fatigue on effort by using a sphincterometric technique. Urethral pressure measurements at rest as compared with after six heavy coughs showed a mean lowering of the urethral pressure of 40% (range 24.5%-90%) in 10 women. Spectral analysis of the electromyographic trace of the striated urethral sphincter at rest and then after coughing confirms that the striated muscle and the periurethral tissues are involved with a marked quantitative lessening of electric sphincter activity. The clinical, physiopathological, prognostic and therapeutic consequences of this new concept are discussed, together with their relationship to other active forces involved in continence.
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PMID:[Active forces of urinary continence and urethral fatigability. Application to stress urinary incontinence in women]. 836 Apr 33

In order to distinguish different types of stress urinary incontinence with the help of urodynamics combined with ultrasound, a study was executed to find out if and how ultrasonographic variables in stress incontinent patients differ from healthy women. Various quantitative variables were defined and compared in the aforementioned groups. Craniocaudal and ventrodorsal related variables were the most discriminative in rest position. During coughing the same directional variables were also discriminative. The difference between stress and rest was significant only for the craniocaudal direction. The often discussed posterior vesical angle had no predictive value. The results of this pilot study support the concept that anatomical differences between stress incontinent patients and healthy women can be detected ultrasonographically. The study further indicates that stress urinary incontinence can be caused by a low rest position of the bladder neck or by a hypermobile bladder neck. Urodynamics combined with ultrasound probably can be applied to distinguish more precisely different types of stress urinary incontinence.
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PMID:Transvaginal ultrasonography: a study with healthy volunteers and women with genuine stress incontinence. 837 44

The existence of urethral fatiguability was demonstrated by a sphinctometric study in 30 women. Comparison of the baseline urethral pressure values and after 6 maximal coughs demonstrated a mean reduction in urethral pressure of 40% (range: 24.5 to 90%) in 10 out of 18 women with stress incontinence. This decreased pressure lasted for several seconds. Spectral analysis of the electromyographic recording of the striated urethral sphincter under basal conditions and then after coughing confirmed the intervention of the striated and periurethral musculature with a marked quantitative decrease in the electrical activity of the sphincter. The clinical pathophysiological, prognostic and therapeutic implications of this new concept are discussed.
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PMID:[Decreased urethral pressure after coughing: the concept of urethral fatigability. Its relationship with active forces of continence]. 848 90

A total of 109 patients submitted to surgery for the correction of urinary stress incontinence (USI) by two different techniques, i.e. anterior colporrhaphy (group I, n = 57) when cystocele grade II/III was present, and Burch procedure (group II, n = 52) when cystocele grade I was present, were reevaluated an average of 5 years after surgery (range: 54-66 months). The curve constructed with the reevaluation data showed a sharp superiority of the Burch technique in terms of correction of USI and associated genital prolapses. There was a progressive recurrence rate that stabilized at 5 years, with values of 78.9% in group I and 40% in group II. Anterior colporrhaphy was ineffective for the correction of any of these parameters in group I. The data clearly show the need to improve the presurgical diagnostic methods for the selection of patients that will benefit from treatment: detailed history of the current disease and auxiliary tests such as Q-tip test, transvaginal ultrasound, and urodynamic study. Other factors were associated with ineffective treatment in both groups, such as hypoestrogenism (20/109), excessive weight gain (19/109) and chronic intestinal constipation and/or coughing present in 36 patients, with recurrence in 28 of them.
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PMID:Evaluation of long-term results of surgical correction of stress urinary incontinence. 869 69


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