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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 test the reproducibility of a new method of determining cough-induced leak-point pressure (CILPP). A cough-induced increased in intra-abdominal pressure was recorded vaginally in 26 women with stress incontinence and urinary leakage was detected electronically. CILPP determinations and short-term pad tests were carried out on two different occasions. Reproducibility is expressed by a coefficient of repeatability as limits of agreement. These indicate that, for 95% of the cases, a repeat measurement of CILPP will be between 0.72 and 1.28 times the first measurement. The coefficient of variation was 11.2%. There was a moderate inverse correlation between pad-test data and CILPP. It was concluded that the new method allows for an accurate determination of CILPP, which represents a quantitative and dynamic assessment of urethral function. The reproducibility of the method appears to be better than that of pad tests and standard urodynamic parameters. The correlation with pad-test data gives support to the validity of the method.
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PMID:Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence. 879 81

Clinical and urodynamic studies were conducted in 19 patients undergoing intrarectal electrostimulation due to post-prostatectomy urinary incontinence. It was corroborated that patients referring incontinence with isolated coughing presented better clinical outcome (80% positive results) than those who also referred urgency-incontinence (44%). Patients with stress incontinence showed positive clinical results post-stimulation in 78% cases. Patients with vesical instability, in 40% cases and patients with mixed incontinence, in 60%. In contrast, elimination of vesical instability was urodynamically proven in 60% cases, but in only 22% with stress incontinence. In mixed incontinence (instability + stress) the instability persisted only in 20% while stress incontinence persisted in 80% cases. The above data would advocate electric stimulation as a therapeutical alternative in post-prostatectomy urinary incontinence.
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PMID:[Results of electric stimulation in the treatment of post-prostatectomy urinary incontinence]. 892 81

Laparoscopic repair of grade 1 to 4 pelvic vault prolapse was performed in 103 patients. All women filled in quality of life questionnaires, and had standing vault examination, transperineal ultrasound examination, and cough stress test. Laparoscopic Burch, paravaginal repair, central pubovesical repair, culdoplasty, sacral colpopexy, and posterior vaginal repair were performed after the type and extent of the prolapse were determined. The majority of the procedures were done as day surgery. Almost all women were able to void spontaneously. At 6 weeks all patients had repeat questionnaires, vault examination, transperineal ultrasound, and cough stress test. No recurrences of vault prolapse or of genuine stress incontinence (GSI) were found at that time. Eighty-nine women were reexamined at 1 one year with the questionnaires, ultrasound vault examination, cough stress, and urodynamics. Of the 89 with GSI, 83 (93%) were objectively dry. Five (6%) of the 89 had recurrent vault prolapse. The laparoscopic cure rate of GSI is comparable with that of open repairs.
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PMID:Laparoscopic Approach for Severe Pelvic Vault Prolapse 907 26

This is a 1-year preliminary report of a 5-year study. Forty-six women with genuine stress incontinence (GSI) were evaluated with multichannel urodynamics before laparoscopic Burch repair and 1 year postoperatively. Reports conclude that as many as 18% of patients develop enteroceles or rectoceles in the first 5 years after Burch repair. To see if prophylactic posterior suspension could prevent this delayed complication, all women had at least a modified culdoplasty. If paravaginal defects, rectoceles, or enteroceles were present, these were also repaired laparoscopically. All patients had a quality of life questionnaire, 24-hour urolog, transperineal ultrasound, cystourethroscopy, cough stress test, and multichannel urodynamics. At 6 weeks they all had a negative ultrasound, cough stress test, and cystometrogram. At 1 year the complete evaluation was repeated. Five women were lost to follow-up. Four of 41 patients had recurrent GSI. One patient had a grade 1 cystocoele with no other signs of pelvic vault prolapse. These are cure rates of 91% and 98% for GSI and pelvic vault prolapse, respectively. The urodynamic studies appear to be comparable with those reported in laparotomy Burch repairs. These findings are encouraging for laparoscopic procedures, but they are short term and it is essential that the patients be followed for 5 years for the data to be clinically relevant.
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PMID:Multichannel Urodynamics for Laparoscopic Burch and Pelvic Vault Repairs 907 27

Prophylactic pelvic support procedures were performed with laparoscopic-assisted vaginal hysterectomies (LAVH) in 91 women to see if the frequency of future pelvic vault prolapse could be reduced. The patients were divided into two groups. In group 1, 43 women were treated with simple LAVH using a suture bipolar technique. In group 2, 48 women had LAVH and prophylactic modified culdoplasties for vault support. Indications for hysterectomy were routine, excluding only patients with significant pelvic relaxation. The work-up included quality of life questionnaire, pelvic ultrasound, standing vault examination, and cough stress test. The study design required follow-up at 6 weeks and 1 year. At 6 weeks all patients were asymptomatic. At 1 year, in group 1, 6 of 40 women had findings of pelvic prolapse and 3 had mild stress incontinence. In group 2, two patients had positive findings and one had stress incontinence. The occurrence rates of 15% and 4% are not statistically significant. It might well represent a trend of increased pelvic prolapse in women who do not have adequate concomitant pelvic support procedures. It will be necessary to follow these patients for 5 years to prove or disprove this concept.
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PMID:Routine Pelvic Support Procedures for Laparoscopic Vaginal Hysterectomies 907 28

Our objective was to determine the effect of cough strength on pressure transmission ratios and establish quantitative and qualitative intra-observer test-retest reproducibility of pressure transmission ratios calculated from dynamic urethral pressure profilometry. The study included 242 consecutive urodynamic evaluations on women without pelvic organ prolapse. Dynamic urethral pressure profiles were performed in duplicate with coughs of different intensities. The analysis included pressure transmission ratios from the proximal 3 urethral quartiles (Q1 through Q3) and the mean pressure transmission ratio calculated from these quartiles. The final diagnoses were stratified into genuine stress incontinence, 135 (56%), and stress continence, 107 (44%). Correlations were strong for pressure transmission ratios from the first versus the second dynamic urethral pressure profile (K = 0.712 for mean). While the variation in cough intensity between hard and soft coughs averaged 30 cm H2O (P < 0.001), correlation's were equally strong between hard and soft cough pressure transmission ratios (K = 0.712 for mean). When mean pressure transmission ratios were stratified into below 90% and at least 90% categories, 83.5% of subjects had test-retest concordance (K = 0.671). Concordance rates were less for stress continent subjects (80.0%; K = 0.527) than for genuine stress incontinence subjects (86.4%; K = 0.679). Pressure transmission ratios appear to have reasonable quantitative and qualitative reproducibility which is unaffected by cough strength. The degree of individual variability limits the utility of pressure transmission ratios to diagnose genuine stress incontinence independent of other, equally variable clinical and urodynamic parameters, but this measure is sufficiently reproducible to be useful in characterizing stress sphincteric function in population studies.
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PMID:Pressure transmission ratio reproducibility in stress continent and stress incontinent women. 913 38

The aim of the study was to determine the intrasubject variability of the pressure-transmission ratio (PTR) with various cough intensities in subjects with genuine stress incontinence. Thirty-six patients with genuine stress incontinence underwent multichannel urodynamics and had a series of pressure-transmission ratios (PTRs) determined with the urethral transducer placed at the point of the maximal closure pressure. Patients were asked to cough with increasing intensities and three to four different cough-induced PTRs were recorded for each subject. The data were analysed using regression analysis, repeated measures analysis of variance and comparison of variance. The PTRs showed a high degree of variability within subjects. The mean within subject standard deviation was 18.5%. The effect of parity, maximal urethral closure pressure and age were insignificant on the variability. Cough intensities of greater than 90 cmH2O have a lesser degree of variability. The mean PTR across all cough intensities was fairly constant in the 82%-87% range. It was concluded that the PTR in an individual has a high degree of variability independent of cough intensity, and cannot be relied upon as a diagnostic measure in subjects with genuine stress incontinence. However, the PTR for the population as a whole was consistent across all cough intensities.
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PMID:Intrasubject variability of the pressure-transmission ratio in patients with genuine stress incontinence. 920 78

The objective of this study was to identify sonographic parameters that could predict successful outcome in women after periurethral collagen implant. Thirty-one women with a diagnosis of stress urinary incontinence with intrinsic sphincteric deficiency underwent one periurethral collagen implant between January and December 1994. Three months after the procedure ultrasound evaluation was performed using a 5 MHz probe placed at the vaginal introitus. Subjective assessment and cough stress test were used to measure outcomes. Twenty-five women were available for evaluation 1 year after the procedure. A successful outcome was found in 18 of the 25 women subjectively (72%) and in 16 objectively (64%). A distance of the collagen from the bladder neck of less than 7 mm was found to be associated with a positive outcome. This threshold was found to have a sensitivity of 83.3%, specificity of 85.7%, a positive predictive value of 93.7% and a negative predictive value of 66.6%.
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PMID:Periurethral collagen implant: ultrasound assessment and prediction of outcome. 920 83

Stress urinary incontinence is a symptom that arises from damage to the muscles, nerves, and connective tissue of the pelvic floor. Urethral support, vesical neck function, and function of the urethral muscles are important determinants of continence. The urethra is supported by the action of the levator ani muscles through their connection to the endopelvic fascia of the anterior vaginal wall. Damage to the connection between this fascia and muscle, loss of nerve supply to the muscle, or direct muscle damage can influence continence. In addition, loss of normal vesical neck closure can result in incontinence despite normal urethral support. Although the traditional attitude has been to ignore the urethra as a factor contributing to continence, it does play a role in determining stress continence since in 50% of continent women, urine enters the urethra during increases in abdominal pressure, where it is stopped before it can escape from the external meatus. Perhaps one of the most interesting yet least acknowledged aspects of continence control concerns the coordination of this system. The muscles of the urethra and levator ani contract during a cough to assist continence, and little is known about the control of this phenomenon. That operations cure stress incontinence without altering nerve or muscle function should not be misinterpreted as indicating that these factors are unimportant.
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PMID:The pathophysiology of stress urinary incontinence in women and its implications for surgical treatment. 937 77

Our objective was to determine whether a positive supine empty stress test is predictive of a low Valsalva leak point pressure (< or =60 cm of water). Evaluation was carried out on 179 patients with a history of genuine stress incontinence confirmed with urodynamic testing. All patients had a supine stress test performed after voiding. Residual urine determinations were all <100 cc. A vesical Valsalva leak point pressure determination (cough and strain) was performed during multichannel urodynamics with 150 cc in the bladder. Urethral profilometry was performed at maximum capacity. There was a statistically significant relationship between a low leak point pressure and a positive supine empty stress test (P < 0.000). The supine empty stress test had a sensitivity of 79% and a specificity of 62.5% for the detection of a low leak point pressure. The negative predictive value was high at 90%. For the age group 50 years and younger the negative predictive value was 95%. However, there was no significant relationship between a positive supine empty stress test and a low maximal urethral closure pressure. We conclude that the supine empty stress test is a useful screening test for a low leak point pressure but not a low urethral closure pressure. Its high negative predictive value is useful in excluding the presence of a low leak point pressure and may help the clinician to determine which patients with genuine stress incontinence need further assessment of the dynamic function of the urethral sphincter.
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PMID:Supine empty stress test as a predictor of low valsalva leak point pressure. 951 44


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