Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ability of conventional artificial filling urodynamic studies (CMG) and ambulatory monitoring during natural bladder filling (AM) to detect phasic detrusor activity (detrusor instability) and incontinence was studied in 52 patients suspected on clinical grounds of having bladder dysfunction, but in whom a CMG had not provided an adequate explanation of their symptoms. Detrusor instability (DI) was found on AM in 31 patients who were not unstable on conventional CMG using the criteria of the International Continence Society: DI was diagnosed on filling in 20 patients and on provocation in a further 11. Incontinence was demonstrated by electronic nappy testing in 23 patients: 13 had urge incontinence due to DI, 7 had genuine stress incontinence alone and 3 had both genuine stress incontinence and detrusor instability. Thus DI was diagnosed significantly more frequently by AM than by CMG. Ambulatory monitoring was more sensitive in the diagnosis of instability and incontinence and it may prove to be a valuable aid in the diagnosis of bladder dysfunction not detected during conventional cystometry.
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PMID:Ambulatory monitoring and electronic measurement of urinary leakage in the diagnosis of detrusor instability and incontinence. 188 40

A cerebral metabolic activator was administered to patients with cerebrovascular dementia to treat urinary incontinence or pollakisuria. The results are of interest as discussed in this paper. This study was carried out on 35 patients (15 males and 20 females) with cerebrovascular dementia with the chief complaint of incontinence or pollakisuria averaging in age 78.1 years with a range of 65 to 92. The underlying disease was cerebral hemorrhage in 4 cases, cerebral embolism in 21 cases and sequelae of cerebral apoplexy in 10 cases. ADL was assessed in all cases by cerebral CT or MRI and Hasegawa's test, a simple test for dementia. Bladder function was evaluated by determining urodynamic tests (CMG, UFM, UPP) before and after medical treatment. Test drug was bifemelane hydrochloride, a cerebrovascular metabolic activator. It was administered at a dose of 150 mg/day for periods of 2 months or more. As a result, bladder symptoms improved in 16/35 patients (45.7%), and mental symptoms in 21/35 (60%). Urine voiding and holding as bladder functions determined by urodynamics tests were not affected at all. The effect of this drug on bladder symptoms is secondary to improvement of mental symptoms, and its most pronounced clinical effect was on dementia.
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PMID:[Effect of the cerebro-metabolism activator (bifemelane hydrochloride) on urinary incontinence and pollakisuria associated with cerebrovascular dementia]. 206 5

Twenty female beagle dogs underwent an L6-7 laminectomy and six dogs each had 25, 50 or 75% constriction of the cauda equina and 2 control dogs had laminectomy only. Cystometrograms were performed pre- and post-operatively and three months after constriction. Cortical evoked potentials were monitored pre- and post-operatively and monthly for three months. After three months of constriction, the cauda equina of these dogs in each group was examined histologically and vascular circulation was examined by latex and India ink injection (Spalteholz technique). The control dogs had normal CMGs and CEPs. Twenty-five percent constriction caused no CMG changes and mild CEP changes. Fifty percent constriction caused no statistically significant CMG changes, major CEP changes and venous congestion of the nerve roots and dorsal root ganglia. Seventy-five percent constriction produced severe CMG changes with detrusor areflexia, increased bladder capacity and clinical incontinence. CEPs also had marked deterioration. Vascular analysis revealed severe arterial narrowing at the level of constriction and venous congestion of the nerve roots and dorsal root ganglia. Blockage of axoplasmic flow and nerve root atrophy was seen in all dogs with 75% constriction. Cortical evoked potentials were the most sensitive predictor of neural compression. CMGs were not sensitive until severe compression was achieved. Bladder dysfunction, i.e., detrusor areflexia, appears to occur with blockage of axoplasmic flow and early sensory changes occur with neurovenous congestion.
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PMID:Urologic function after experimental cauda equina compression. Cystometrograms versus cortical-evoked potentials. 225 71

Continuous simultaneous recordings of the urethral and intravesical pressures (pves) during medium fill cystometry (CMG) were performed in 1) twelve healthy fertile volunteers, 2) nine healthy postmenopausal volunteers, 3) nine genuine stress incontinent and 4) sixteen women with unstable detrusor. During the cystometry the urethral pressure rose in two stages. Approximately 70% of the maximum urethral pressure (MUP) rise occurred within the first minute. This was followed by a gradual increase to a maximum at the conclusion of the CMG. The bladder pressure showed a similar pattern with 10-20% of the intravesical pressure rise occurring during the first minute of the cystometry. Both active and passive forces seemed to participate in the MUP and maximum urethral closure pressure (MUCP) rise. This urethral pressure increment was found in all the women except the stress incontinent, reflecting deficient activity of the pelvic floor musculature in this category of patients. Changing position from supine to sitting increased the pves more than the MUP. Consequently a decrease in the MUCP was noted. The MUP increment during position change was due to both passive intraabdominal pressure (pabd) transmission and increased pelvic floor muscle activity but it was obviously not sufficient to maintain the pressure difference in any of the groups. Continuous recordings of the intraurethral pressure showed a significantly lower MUP in the postmenopausal and stress incontinent women both at rest and during the CMG. The group with unstable detrusor contraction showed apart from this no difference compared to healthy fertile women. These changes were detectable using continuous registration which stresses the value of such measurements in the investigation of urinary incontinence.
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PMID:Urethral pressures during bladder filling. 263 18

Sixteen patients were treated for incontinence by S3 blocks when other means had failed. CMG had demonstrated detrusor instability in 14 and was not performed in 2 patients. Ten patients are continent, 2 are improved. There have been no complications or side effects. These results suggest that S3 blocks should be considered as an additional method of treatment of detrusor instability.
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PMID:An appraisal of S3 blocks in the management of incontinence. 715 Sep 27

We investigated dorsal penile stimulation for control of incontinence in nine spinal cord impaired (SCI) patients, using a battery-powered home-use stimulator connected to surface electrodes (Unipatch). The efficacy of the penile stimulation was assessed by urodynamic evaluation (NL-2, LifeTech) and surface electrodes (Unipatch); baseline and repeat cystometries (CMG) with and without stimulation were done. Stimulation for home use was begun at threshold parameters for inducing perineal contractions and, after two weeks, was adjusted based upon results. Two subjects successfully completed the study and became continent. One of these patient's CMG demonstrated hyperreflexia and his volume increased from 110 ml to 150 ml after the stimulation protocol. The most effective stimulating parameters were 5 pps, 250 microsec, pulse width and 40 ma current. The other patient also had a hyperreflexic bladder and improved on the protocol. The remaining seven patients did not complete the study for several reasons. Three patients had CMG's that demonstrated areflexia. Stimulation did not alter their bladder function and they dropped out of the program. Three other subjects withdrew because of bothersome sensations even at subthreshold levels and they complained that the technique was cumbersome. Finally, one patient with significant hyperreflexia and incontinence withdrew after trying unsuccessfully and diligently for 10 days. Our encouraging results in two patients with hyperreflexic bladders and decreased sensation suggest that this modality may be effective in this patient group.
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PMID:Management of incontinent SCI patients with penile stimulation: preliminary results. 806 87

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

Urodynamic testing provides a quantitative assessment of the function of the small animal lower urinary tract. Most commonly these techniques are utilized to assess urethral tone (urethral pressure profile or UPP) and bladder detrusor muscle function (cystometrogram or CMG). A UPP may be indicated in cases of canine and feline micturition disorders. Examples include suspected primary sphincter mechanism incontinence (PSMI), ureteral ectopia, other congenital abnormalities, suspected neurological disorders, and mechanical or functional urethral obstruction. A UPP can be performed effectively utilizing human dedicated equipment. A CMG may be indicated to assess detrusor function in all of the above cases as well as cases of suspected atonic or infiltrated urinary bladder. This procedure can also be performed using the same human equipment. These tests are useful not only in providing an accurate diagnosis, but also in providing a sensitive prognostic indicator for clinical outcome of micturition disorders with and without pharmacological or surgical therapy. A leak pressure point may also be established in dogs with urinary incontinence, and may be even more sensitive than a UPP to predict clinical incontinence in some cases.
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PMID:Urodynamic testing in the diagnosis of small animal micturition disorders. 1582 32

This article defines the concept of bladder wall compliance, discusses various means of measuring or assessing compliance, and reviews its clinical relevance. Based on existing evidence, low bladder wall compliance is attributable to increased detrusor muscle tone during bladder filling or changes in the viscoelastic properties of the bladder wall that impede the bladder wall's ability to stretch. While one can identify the individual components that compromise compliance, the filling CMG is only able to detect whole bladder wall compliance (for example, the combined effects of increased detrusor muscle tone and compromised viscoelastic properties of the bladder wall). From a clinical perspective, whole bladder wall compliance is divided into two categories: normal and low. Low bladder wall compliance is clinically relevant because of its potential to produce upper urinary tract distress, and there is increased risk for febrile urinary tract infections, ureterohydronephrosis, vesicoureteral reflux, renal scarring, compromised urinary tract function, and urinary incontinence because of its direct influence on the bladder outlet. It may produce pain and pressure in the patient with preserved sensations of bladder filling. Low bladder wall compliance is associated with a variety of clinically relevant disorders, including neurogenic bladder dysfunction, pelvic irradiation, interstitial cystitis, and radical prostatectomy.
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PMID:Traces: making sense of urodynamics testing--Part 6: Evaluation of bladder filling/ storage: bladder wall compliance and the detrusor leak point pressure. 2191 95