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

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

Since urinary incontinence is one of the most frequent female health problems and may severely affect a woman's life quality, knowledge about its pathophysiology, evaluation and therapy is very important. Even basic diagnostic tests can determine the type of incontinence (stress or urge urinary incontinence) thus permitting appropriate therapy to be initiated. The patients history, micturition diary, clinical evaluation, perineal ultrasound and urinalysis are important parts of these basic diagnostic tests. The positive stress cough test and the typical symptoms such as urine loss during physical activity point to the diagnosis of stress urinary incontinence. Frequency, nocturia and urgency with or without urine loss as well as more objective criteria such as micturition diaries and urinalysis indicate urge incontinence. Questions to help determine how quality of life is affected by the incontinence symptoms aid in deciding how urgent the treatment is. An urodynamic evaluation together with perineal ultrasound and cystoscopy is performed in patients with complex or recurrent urinary incontinence after surgery or with micturition disorders.
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PMID:[Urinary incontinence in the woman--pathophysiology and diagnosis]. 1280 94

Stress urinary incontinence (SUI) is the accidental leakage of urine associated with physical activities such as running, jumping or lifting or with sneezing and coughing. For many patients it can be a very bothersome symptom, causing social isolation, loss of self-esteem and increased financial outlays. Although there is currently no medication approved worldwide for the treatment of SUI, a variety of off-label agents are sometimes prescribed. Duloxetine (LY-248686; Eli Lilly), a new centrally acting compound with dual activity as a serotonin and noradrenaline re-uptake inhibitor, offers a promising new approach for treatment. Due to its inhibition of presynaptic neuron re-uptake of serotonin and noradrenaline in the sacral spinal cord, duloxetine is believed to increase the strength of urethral sphincter contractions and thereby prevent accidental urine leakage by increasing urethral closure pressure. In three published trials in women with the predominant symptom of SUI, duloxetine significantly reduced the number of incontinence episodes compared to placebo. Adverse events were usually observed early in treatment, were mild-to-moderate in severity and were transient. Nausea was the most common reason for discontinuation.
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PMID:Duloxetine: a serotonin-noradrenaline re-uptake inhibitor for the treatment of stress urinary incontinence. 1294 99

Stress urinary incontinence (SUI) is the involuntary loss of urine associated with physical activities such as running, jumping, or lifting, or with sneezing and coughing. For many patients it can be a very bothersome symptom, causing social isolation, loss of self-esteem, and increased expenses. Although there is currently no single medication approved worldwide for the treatment of SUI, a variety of off-label agents are often prescribed. This paper reviews the current pharmacological treatment options for SUI, describing the mechanism of action, efficacy, and possible adverse effects of each. A new centrally-acting compound with dual activity as a balanced serotonin and norepinephrine reuptake inhibitor, duloxetine, may offer a promising new approach for treatment.
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PMID:Pharmacological agents used for the treatment of stress urinary incontinence in women. 1459 20

The purpose of this study was to evaluate the feasibility, safety and efficacy of performing the Burch urethropexy (BU) and the abdominal paravaginal repair (APR) through a 1.5-2.5 in suprapubic incision. A prospective clinical study was undertaken by four urogynecologists. Seventy-three patients, each with a urodynamic and clinical diagnosis of genuine stress incontinence, underwent a BU procedure, with 33 of the 73 having concomitant APR through the same incision. The duration of surgery and any complications were recorded. Postoperative outcome tests included subjective incontinence questionnaire, cough stress testing, pad testing, measurement of residual volumes, and analgesia requirements. The BU procedure was accomplished in 72 of 73 patients, with 1 requiring conversion to a 5 in incision. The mean operative time was 64.6 +/-21.9 (SD) min. Intraoperatively, 1 patient was noted to have a suture in the bladder. All patient having only a BU (40) went home on the day of surgery or the first postoperative day, and all patients with BU and APR went home within 2 days. All but 1 patient met the criteria for catheter removal within 7 days, with 1 patient suffering obstructive voiding. At a mean follow-up of 9 months, cough stress test and questionnaire demonstrated complete cure in 70 of 72 patients tested. Pad testing confirmed cure in all of the 46 patients who consented to the test. We conclude that the standard Burch procedure and paravaginal repair can be accomplished safely and with excellent short-term efficacy through a 1.5-2.5 in incision.
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PMID:Mini-incisional Burch urethropexy: a less invasive method to accomplish a time-tested procedure for treatment of genuine stress incontinence. 1475 94

This study forwards a new surgical approach we have performed in the treatment of genital prolapse, associated or not with stress urinary incontinence. The study used 150 patients with genital prolapse and stress urinary incontinence in various stages, and lasted from 1985 until 2001. Four-five threads of silk were passed through the uterine muscle in the isthmus area, just below the bladder-uterus recess, and fastened to the supra-pubic ligament complex. Although the mechanical basis for this surgical approach is not entirely clear, no relapse, incident or post-surgery complications (bladder voiding problems, enteroceles, detrusor instability, urethra or bladder bottom lesions, incomplete urinary retention or clearance, hematoma or abscess of the Retzius space) were noted in any of the studied cases. The suspension of the uterine isthmus on to the supra-symphyseal fibrous complex leads to an increase in urethral closure pressure during the occasional increase of intra-abdominal pressure (cough, laughter, spontaneous movements, walking), the results being superior to the other methods used for treating genital prolapse.
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PMID:The use of the supra-pubic fibrous complex in isthmic hysteropexies. 1475 75

Stress urinary incontinence (SUI) has been defined as the complaint of involuntary leakage of urine on effort, exertion, sneezing or coughing (Abrams et al, 2002). It becomes known as urodynamically proven stress incontinence (USI) when filling cystometry (a test of bladder function) shows a rise in intra-abdominal pressure, without a detrusor muscle (bladder muscle) contraction, causing urine loss via the urethra.
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PMID:Current treatments for patients with stress urinary incontinence. 1476 55

The normal pelvic floor functions as a balanced synergistic system composed of muscle, connective tissue (CT), and nerve components, with CT being the most vulnerable. The aim was to address a wide range of pelvic floor dysfunctions by strengthening all possible components of the system with minimal time loss, weaving every element of treatment seamlessly into a daily routine. The study group consisted of patients from a tertiary referral pelvic floor clinic who, after testing, opted for nonsurgical treatment of their problem. There were no exclusion criteria. The patients had presented with symptoms which included stress, urge, frequency, nocturia, abnormal emptying and pelvic pain, and the fate of these was tracked prospectively. The regime comprised four visits in 3 months. An anatomical classification guided diagnosis of anatomical defects in the anterior, middle and posterior compartments of the vagina. HRT was administered to all patients, electrotherapy 20 min per day for 4 weeks, squeezing 3 x 12 per day, reverse pushdowns 3 x 12 per day and squatting or equivalent up to 20 min per day. Of 147 patients (mean age 52.5 years), 53% completed the programme. Median QOL improvement reported was 66%, mean cough stress test urine loss reduced from 2.2 g (range 0-20.3 g) to 0.2 g (range 0-1.4 g), p =<0.005, and 24-h pad loss from a mean of 3.7 g (range 0-21.8 g) to a mean of 0.76 g (range 0-9.3 m), p =<0.005. Frequency, nocturia and pelvic pain were significantly improved ( p=<0.005). Residual urine reduced from mean 202 ml to mean 71 ml ( p=<0.005). This method extends indications for nonsurgical therapy beyond stress incontinence, and the results appear to encourage this approach. Confirmation by other investigators is required.
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PMID:Synergistic non-surgical management of pelvic floor dysfunction: second report. 1501 37

Development of an animal model of stress urinary incontinence is dependent on a measure of urethral resistance, such as leak point pressure (LPP). However, animals will not cough or perform Valsalva maneuvers upon request. The aim of this study was to use urodynamics to compare bladder pressures during spontaneous voids (SV), anesthetized LPP measurement, and induced sneezing in female rats. A suprapubic catheter was implanted in the bladder dome of 10 female rats. Two days later, the rats were tested urodynamically under urethane anesthesia. The bladder was emptied and filled with saline. The abdomen was then depressed manually to increase abdominal pressure while bladder pressure was measured. The bladder pressure when leakage occurred was taken as LPP. In addition, the rats were stimulated to sneeze by cutting off a whisker and using it to tickle the nostril. Both peak pressure and increase in pressure during LPP (43.4 +/- 3.6 and 33.1 +/- 3.8 cm H2O, respectively) were significantly higher than pressures during both SV (30.4 +/- 3.8 and 19.3 +/- 3.4 cm H2O, respectively) and sneeze (9.5 +/- 0.7 and 2.6 +/- 0.5 cm H2O, respectively). The time course of a sneeze (0.6 +/- 0.2 sec) was significantly shorter than the time course of both LPP (4.4 +/- 0.5 sec) and SV (6.9 +/- 1.3 sec). No rat leaked from a sneeze unless the sneeze triggered an SV. LPP triggered a SV in 5 rats and sneeze triggered a SV in 6 rats. With urodynamic measurement, it is possible to easily distinguish between LPPs, SVs, and sneezes. LPP can provide a quantifiable measure of decreased urethral resistance, whereas induced sneezes can provide a diagnostic test for severe incontinence.
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PMID:Methods of testing urethral resistance in the female rat. 1517 26

Stress urinary incontinence (SUI) is the accidental leakage of urine associated with physical activities such as running, jumping or lifting, or with sneezing and coughing. Worldwide, SUI is a highly prevalent condition, both in young and elderly women, and is a condition fraught with social isolation, loss of self-esteem and significant financial burden. Most women with SUI assume that it is an inevitable part of aging and "suffer in silence", relying on absorbent pads or lifestyle changes to cope with their condition.Unfortunately, for those who do seek medical treatment, the absence of effective and well tolerated pharmacological treatments for SUI limits the clinician's choices to behavioural modification, biofeedback and surgery. Many of the nonsurgical approaches have low success rates, particularly in the elderly and more severely afflicted. Although most continence surgeries have been reported to produce very high cure rates, many women are willing to live with their condition rather than undergo such invasive options. In an attempt to help these patients, some physicians prescribe off-label agents, including tricyclic antidepressants such as imipramine, alpha- and beta-adrenoceptor agonists, and estrogen replacement therapy. The use of these therapies has been limited by unpredictable results and adverse reactions. In addition, acetylcholine receptor antagonists are often prescribed for SUI, despite the fact that these medications have never been shown to be effective in this condition. This lack of a reliable pharmaceutical agent led to the development of duloxetine, a balanced dual reuptake inhibitor of serotonin and norepinephrine that is also being studied for the treatment of major depressive disorder. Based on in vivo data in animals, duloxetine is believed to increase the strength of urethral sphincter contractions and, thereby, prevent accidental urine leakage by increasing urethral closure forces. In clinical trials in women with SUI, duloxetine has demonstrated efficacy in reducing incontinence episodes and increasing the quality of life with no serious adverse effects. Nausea was the most common adverse event; however, in most patients it was reported early in treatment, mild-to-moderate in severity and transient. A medication such as duloxetine, if approved, would go a long way towards expanding the available treatment options for patients with SUI.
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PMID:Pharmacotherapy for stress urinary incontinence : present and future options. 1571 22


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