bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of the cough and standing urethral pressure profile in the diagnosis of stress incontinence
Authors: Cadogan Mark , Awad Said , Field Christopher , Acker Kelly , Middleton Susan 
Published: March 2007

AbstractControversy over the accuracy of the urethral pressure profile (UPP) and its role in the diagnosis of stress urinary incontinence (SUI) is unresolved. Different UPP methods and techniques have been introduced. In this study, we examined 78 female patients with mixed symptoms of stress and urge incontinence. Each had a history, physical examination, cystoscopy, and urodynamic assessment, which consisted of a cystometrogram (CMG), UPP (supine and standing), and “cough profile” by the Brown and Wickham (BW) method and also UPP (supine) and “cough profile” with the microtip transducer (MTT). The final diagnosis in 38 patients was SUI (group I) and in 40 patients, no SUI (group II). The maximum urethral closure pressure (MUCP) supine and standing was significantly lower in group I, but there was no significant difference between the two groups in the transmission index (TI) of the “cough profile.” MUCP standing showed the least overlap between the two groups, and with a cutoff point at 40 cm H2O, the overall diagnostic accuracy was 69%, with 39% sensitivity and 98% specificity. By combining MUCP supine and standing and using cutoff points at 40 cm H2O and 35 cm H2O, respectively, the overall diagnostic accuracy was 72%, with 47% sensitivity and 95% specificity. We believe that the UPP is a useful ancillary tool in the assessment of complicated cases of urinary incontinence in the female.
Cystometry: H2O or CO2 as filling medium? A literature survey of the influence of the filling medium on the qualitative and the quantitative cystometric parameters
Authors: Jørgensen Lisbeth , Lose Gunnar , Andersen Jens Thorup 
Published: March 2007

AbstractA literature survey is presented on the influence of the filling medium on qualitative and quantitative cystometric parameters. Only ten relevant reports comparing H2O and CO2 cystometry were found. From the reports the following parameters were extracted: size and description of study population, randomisation of sequence of the cystometries (H2O/CO2), patient position, filling rates, catheters used, and qualitative and quantitative cystometric parameters.The conclusions that can be drawn from the ten studies analysed are that the qualitative classification is independent of the used filling medium (CO2 or H2O). However, the quantitative parameters (first sensation and maximal cystometric capacity) decrease statistically significantly when CO2 is used as the infusion medium. However, we found it difficult to compare the studies, since investigative modalities known to influence the obtained cystometric data differed significantly from study to study.
New proposal for the determination of the nerve conduction velocity of the dorsal nerve of the penis
Authors: Fanciullacci F. , Garavaglia P. F. , Colpi G. M. , Beretta G. , Sandri S. , Zanollo A. 
Published: March 2007

AbstractThe dorsal nerve of the penis reportedly affects sexual function. The method previously used to measure the nerve conduction velocity (NCV) of the dorsal nerve of the penis divided the distance between the stimulating and recording electrodes by the latency to the negative peak of the action potential. According to Bradley, the NCV in normal men was 33 m/sec ± 3.8. Measurement of the NCV by this method revealed that the velocity decreased when the distance between the stimulating and recording electrodes was shortened. Furthermore, these different measurements were linearly related. As a result, NCV values were calculated by means of a regression equation (see text for more specific details). In normal subjects, it resulted in faster values than those reported previously. The mean value was 46.4 m/sec.
Hydrodynamic aspects of pyelocalyceal peristalsis
Authors: Ohlson Lars 
Published: March 2007

AbstractThis study was undertaken to determine the nature of pressure changes in manometric studies of renal pelvis and calyces. In previous studies in pigs it has been assumed that pressure increases occur in the contracting segments of the renal pelvis and calyces, but our observations suggested that these increases were actually due to distension of noncontracted segments. Pressures were recorded with two catheters introduced percutaneously into the pyelocalyceal system with simultaneous video recording of the fluoroscopic image. There was no pressure rise in the calyces or the renal pelvis when these segments contracted; however, pressure rose when the noncontracted calyces were distended by a remote contraction ring. These findings confirmed the observations at kinetic urography. They agreed with the hydrodynamic experience that the pressure in a ring‐shaped contracted segment is lower than upstream and downstream of that segment. It was concluded that if the porcine pyelocalyceal system is a valid model of the human, the pressure increases, assumed to be contractions, were actually caused by the injection and distension of the noncontracted segments.
The influence of filling rates and sympathectomy on bladder compliance in the chloralose‐anaesthetised cat
Authors: Flood Hugh D. , Downie John W. , Awad Said A. 
Published: March 2007

AbstractThe effect of total sympathectomy (hypogastric nerve and sympathetic chain section) on the relationship between bladder compliance and filling rate has never been studied over the full range of physiological filling rates. In a series of chloralose‐anaesthetised cats, we examined the effect of total sympathectomy on bladder stiffness (the inverse of compliance) at filling rates from 1 to 50 hourly diuresis (HD) units. In control animals the slopes of regression lines fitted from 5 to 30 (n = 7) or 5 to 50 (n = 3) HD units were equal to or approached 0 (mean slope = .002 ± .0008 SE). After sympathectomy there was a statistically significant increase in stiffness at filling rates from 5 to 30 HD units (P < .005), and, although there was a trend for increased stiffness at higher filling rates, the increase in the slopes of the regression lines did not reach statistical significance (.05 < P < .1). The volume threshold for micturition at a filling rate of 5 HD units was significantly lowered after sympathectomy (P ≤ .0005). We conclude that the sympathetic nervous system makes a significant contribution to the control of bladder stiffness (and therefore compliance) within the range of physiological filling rates and that this effect may be more important at higher rates of filling. The sympathetic nervous system also has a role in determining the volume threshold for micturition at physiological filling rates.
Rapid filling cystometry for predicting poor symptomatic results after transurethral prostatic surgery
Authors: Nielsen Knud T. , Graversen Peder H. , Madsen Paul O. , Bruskewitz Reginald C. 
Published: March 2007

AbstractTwenty‐seven patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) were evaluated preoperatively by standard urodynamic investigation and by rapid filling cystometry (RFC). Rapid filling cystometry was performed by injecting a maximum of 120 ml saline into the empty bladder through a catheter at a constant flow rate over 4 seconds. Twenty‐three patients were reexamined 3 months after transurethral prostatic surgery. Three patients had not improved symptomatically. None of these three had uninhibited detrusor contractions (UDC) by RFC, but medium filling cystometry revealed UDC in 2 of the patients, both pre‐ and postoperatively. Rapid filling cystometry, as used in this study, correlated poorly with medium filling cystometry and failed to identify the patients that will not benefit from prostatic surgery due to persistent postoperative UDC.
The burch colposuspension for urinary incontinence in patients with stable and unstable detrusor function
Authors: Jørgensen Lisbeth , Lose Gunnar , Mortensen Svend O. , Pedersen Lars Mølsted , Kristensen Jørgen Kviss 
Published: March 2007

AbstractEighty patients with urinary incontinence, 61 with stable and 19 with unstable detrusor function, were evaluated preoperatively and postoperatively after Burch colposuspension. The cure rate in the stable group was found to be 75% vs. 26% in the unstable group. This difference was highly significant (P < 0.0005). In the unstable group, the major cause of failure was persistent instability. The great controversy in the literature as to the prognostic significance of preoperatively demonstrated detrusor instability when treating urinary incontinence by conventional antiincontinence surgery is suggested to be due to: (1) differences in the cystometric techniques, hence the populations classified with detrusor instability; and (2) difficulties in identification of instability secondary to bladder neck incompetence. The cystometric technique described in this study is considered sufficiently physiologic to allow a reliable identification of true instability, thereby selecting patients who will not benefit from surgery. It is emphasized that there is a need for a thorough standardization of the cystometric technique for classifying true instability and as a basis for comparative studies.
Short pad test: Standardisation of method and comparison with 1‐hour test
Authors: Mayne C. J. , Hilton P. 
Published: March 2007

AbstractThree different exercise pad tests were performed on 33 patients with known urinary incontinence. It was found that prolonging the test or carrying it out at a specified bladder volume increased the detection of leakage. There was, however, no direct correlation between the three different methods.
Pressure variations in the female urethra measured by the infusion technique: Is it an artifact?
Authors: Colstrup Hans , Lose Gunnar , Jørgensen Lisbeth 
Published: March 2007

AbstractThe aim of this study was to investigate the possibility that pressure variation in the female urethra, as registered by the Brown‐Wickham technique, is an artifact due to infusion of fluid into the urethra. Sixteen women with various lower urinary tract disorders underwent pressure registration in the urethral high pressure zone for 5 minutes using the infusion method, followed by pressure registration using a water column pressure head. In nine patients, well‐defined pressure variations were observed during infusion; similar stepwise pressure decreases were found in these patients using the water column method. Because the stepwise decreases with the latter method can be due only to genuine relaxations of the urethral wall, obtaining similar patterns with these two techniques indicates that the infusion method is reliable in detecting urethral pressure variations.
Evidence for local neural modulation of sympathetic influences on the feline bladder
Authors: Rudy Delbert C. , Downie John W. 
Published: March 2007

AbstractIt is known that resting conditions of bladder volume and pressure influence the response of the cat bladder in situ to sympathetic nerve stimulation. We observed that this was also true when the bladder was decentralized by cutting the sacral spinal roots, the hypogastric nerves, and one sympathetic chain. Under these conditions, elevating intravesical pressure by means of a reservoir of large surface area connected to the bladder resulted in an enhancement of the beta‐adrenoceptor‐mediated dilatory component of the response to stimulation of either the sympathetic chain or the hypogastric nerves. In order to test whether this enhancement was the result of mechanical or end‐organ effects, the change in response to ia isoprenaline was also evaluated. Although the response to isoprenaline was modestly (2‐fold) increased at intravesical pressures of 20–30 cm H2O, the increase in response to hypogastric nerve stimulation (8.5‐fold) was significantly greater. The increase in response to sympathetic chain stimulation was intermediate, but only one chain was stimulated. Thus, end‐organ or physical factors have some influence on the dilatory response. However, there must be another modulatory component that exerts an effect on the neurally mediated dilatation but not on that produced by isoprenaline. This modulation appears to be activated by bladder distension and to be directed at the nerves, either on their terminals or at the intramural or plexus ganglia. Candidate mechanisms are humoral compounds (e.g., eicosanoids) or a local neural network.
Endocrine influences on the detrusor of male and female cats
Authors: Theobald Robert J. , Zepp E. A. , Westhoff Rebecca 
Published: March 2007

AbstractThe effects of ATP, adenosine (ADS), β,γ‐methylene ATP (APPCP), norepinephrine (NE), and hypogastric nerve stimulation (HGS) on urinary bladder responsiveness have been studied in male and female cats. Recent studies indicated binding sites for estradiol and testosterone in the urinary tract of animals. Other studies have demonstrated that estrogen alters the effects of certain agonists in urinary tract smooth muscle, although the mechanism of this effect is not known. The present study was designed to determine if differences occurred in the response of bladder smooth muscle in male vs. female cats to various stimuli and if surgical or drug pretreatment alters the response.The results of these experiments indicate differences between the response of the urinary bladder in female and male cats to various stimuli and that various pretreatments can alter the detrusor response to selected stimuli. In particular, detrusor of female cats was less responsive to most stimuli than detrusor of male cats, including stimuli that induced inhibition of pelvic‐nerve‐evoked bladder contractions (such as norepinephrine) and stimuli which induced bladder contractions (such as ATP). Also, gonadectomy altered the response of the detrusor making it more responsive to purine inhibitory stimuli, while having a mixed effect on detrusor responsiveness to excitatory stimuli. Pretreatment of cats with a gonadotropin‐releasing hormone antagonist also altered detrusor responsiveness, both inhibitory and excitatory agonists in a variable manner, increasing the magnitude of most responses. In addition to the above‐stated differences, the data also proved to underscore some similarities in the response of male and female cats to adrenergic and cholinergic stimuli. These studies imply that sex hormones influence detrusor response to certain purinergic stimuli and that alteration of sex hormone levels by surgery or medication can impact lower urinary tract function.
Detrusor overactivity
Authors: Coolsaet Bo L. R. A. , Elhilali Mostafa M. 
Published: March 2007

AbstractDetrusor pressure is only a partial reflection of bladder wall force. In order to better standardize the results of clinical studies, bladder wall activity has to be taken into account by relating detrusor pressures to volume levels.The 15 cm H2O threshold level is misleading. Tonic and phasic pressure changes have to be clearly distinguished. Standardization of technique can be improved by using diuresis cystometry.Urethral mobility and dysfunction have to be further investigated in relation to detrusor activity.Detrusor overactivity may be caused by factors which also cause stress incontinence and is therefore no contra‐indication for culposuspension. The occurrence of detrusor overactivity after culposuspension cannot be predicted. It can be treated pharmacologically and in case of resistance to therapy by an augmentation cystoplasty such as a CLAM operation. Investigation of the urethra is therefore more important than a cystometrogram prior to a culposuspension. A technique is described.Genuine stress incontinence is not a useful urodynamic diagnosis.In the aging male, detrusor overactivity is more frequent, with or without obstruction. In patients with benign prostatic hypertrophy and detrusor overactivity resistant to treatment, prostatectomy would be acceptable therapy.
Surgical treatment of anatomical stress incontinence
Authors: Siegel Andrew L. , Raz Shlomo 
Published: March 2007

AbstractThe condition Stress Incontinence may be classified as (a) anatomical (AI) and (b) due to intrinsic sphincter damage (ID). While anatomical incontinence is due to anatomical malposition of a normal sphincteric unit in intrinsic damage, the sphincteric unit is abnormal (damaged from multiple surgery, radiation, neurologic disease, etc). The goal of surgery for AI is to reposition the bladder neck and urethra in a high, fixed retropubic position without obstruction. With improvements in the surgical techniques and a better understanding of the anatomical landmarks a clear trend has evolved in recent years toward vaginal approach. Important principles of the vaginal approach include mobilization or the urethra and bladder neck, precise placement of the suspension sutures in sturdy tissue (endopelvic fascia), fingertip guidance of a ligature carrier through the retropubic space, cystoscopy control and tying the sutures without tension. The advantages are simplicity, less morbidity and providing equal or better results than the abdominal approach. AI is only a symptom of pelvic prolapse and concomitant pathology like rectocele, enterocele and uterine prolapse should be addressed at the time of surgical repair. The pathophysiology, classification and different modalities of treatment for anatomical incontinence are discussed.
Anterior sacral root stimulator (Brindley): Experiences especially in women with neurogenic urinary incontinence
Authors: Madersbacher H. , Fischer J. , Ebner A. 
Published: March 2007

AbstractSix women and one man with complete (or almost complete) suprasacral lesions and with unbalanced reflex bladder and otherwise uncontrollable reflex incontinence received a radiolinked anterior sacral root stimulator using the intradural approach. At the same time the relevant posterior sacral roots were cut to abolish spontaneous reflex detrusor contractions. All patients were able to empty the bladder with physiologic detrusor pressure, with no or minimal residual urine, and they achieved urinary continence. Pre‐ and postoperative urodynamic findings are given as well as the intra‐operative details. The aims of this procedure, balanced voiding and urinary continence, were achieved in all seven patients; follow‐up in this series ranged from 6 months to 2 years. Our findings confirm the excellent results reported by Brindley and others with 155 implantations of an anterior sacral root stimulator worldwide. In our series so far no technical problems — either with the implant or with the external stimulation unit — have occurred; exact setting of the electric stimulation parameters provides physiologic detrusor pressures, and although micturition is achieved by poststimulus voiding, no increase of trabeculation could be observed. Achievement of urinary continence depends on the effect of the rhizotomy of the relevant sacral posterior roots performed at the same time intradurally. Further observation time will be necessary to prove its effectiveness in the long run. Even with these arguments in mind the results so far justify the implantation of an anterior sacral root stimulator together with a posterior root rhizotomy, especially in female patients with unbalanced reflex bladder together with reflex urinary incontinence which cannot be managed otherwise.
Abdominal approach for implantation of the A.S. 800 artificial urinary sphincter in females
Authors: Light J. Keith 
Published: March 2007

AbstractThe artificial urinary sphincter has been used with success in female patients with neuropathic bladder dysfunction and resultant urinary incontinence as the device has reliably substituted for the nonfunctioning sphincteric mechanism in these patients. A combination of augmentation cystoplasty to create a low pressure reservoir with the artificial urinary sphincter was successful in restoring continence in 92% of pediatric patients with meningomyelocele where other measures had failed. Use of the artificial urinary sphincter in patients with severe, recurrent stress incontinence is likewise highly successful in restoring continence. The potential disadvantage to the sling procedure of having to perform prolonged self‐intermittent catheterization is avoided. Careful preoperative urodynamic evaluation is essential, however, to ensure that a stable bladder with no outlet obstruction is present. The abdominal approach to insert the artificial urinary sphincter avoids the potential of vaginal contamination with subsequent device infection. The operative technique to successfully accomplish this is fully described. The vascularity of the trigonovaginal septum is crucial for success with this approach. Conditions such as previous radiotherapy and excessive atrophy adversely affect the ultimate success of the operation because of decreased tissue perfusion. This applies whether the vaginal or abdominal approach is used to insert the device.Careful attention to preoperative evaluation and surgical technique will result in a high degree of success.
Techniques and results in the implantation of the artificial urinary sphincter in women with type III stress urinary incontinence by a vaginal approach
Authors: Appell Rodney A. 
Published: March 2007

AbstractThirty‐four women with type III stress urinary incontinence underwent implantation of the artificial urinary sphincter (AUS) for control of urination using the AMS #800TM device via a combined vaginal and minimal retropubic approach. The deliberate opening of the vagina facilitates placement of the sphincteric cuff in its proper position and serves to prevent urethral or bladder neck damage without increasing the risks of cuff infection or erosion. Results show no erosions, no detrusor instability, four patients on intermittent self‐catheterization, and three patients requiring repeat surgery for mechanical problems. These results indicate that the AUS is a viable alternative in the management of this difficult group of incontinent women and that implanting surgeons should not fear entering the vagina during implantation, but should deliberately do so to facilitate surgical placement of the cuff while protecting the urinary organs and reducing operating room time.
Interference pattern in perineal muscles: I. A quantitative electromyographic study in normal subjects
Authors: Aanestad Ø. , Flink R. , Stålberg E. 
Published: March 2007

AbstractThe electromyographic pattern (EMG) in two perineal muscles, the external anal sphincter muscle and the puborectalis muscle, was examined in 30 normal subjects consisting of women aged 24–77 years, using a concentric needle electrode. The interference pattern in the two muscles was recorded at rest and at maximal voluntary activation and analyzed with a computerized technique. The number of turns and the mean amplitudes in the interference pattern were measured and the recorded differences between the two investigated muscles as well as the differences compared to other striated extremity muscles are discussed. This technique (T/A analysis) has been shown to differentiate between neurogenic and myopathic changes in a weak muscle, and it is proposed that the technique could be useful in characterizing disturbances in perineal muscles in patients with micturition or defaecation dysfunctions.