bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathophysiologic subdivision of genuine stress incontinence
Authors: Lose Gunnar , Colstrup Hans 
Published: March 2007

AbstractA pressure/cross‐sectional‐area probe was used to describe permanently and adjunctively acting urethral closure forces and urethral deformability at the bladder neck and midure‐thrally in 30 females with genuine stress incontinence (GSI). The permanent closure forces were described in terms of urethral pressure and elastance and the adjunctive closure forces in terms of power generation during coughing and squeezing. Urethral deformability was assessed from related values of urethral pressure and elastance.Twenty‐eight (93%) patients had reduced permanent and/or adjunctive closure forces both at the bladder neck and midurethrally. Various combinations of reduced closure forces were found at the two sites of measurement. Different pathophysiological subgroups could be defined. In the largest group of patients both the permanent and the adjunctive closure forces were reduced. A small group of patients was characterized by decreased urethral deformability. It is concluded that both the bladder neck and mid‐urethral sphincter mechanisms are weakened in GSI. The underlying cause is not a single defect in urethral physiology; it is most often the result of weakening of one or more closure mechanisms (intramural and/or extrinsic) and the inability of the other to compensate. The identification of pathophysiologic subgroups may improve the scientific basis for selection of treatment modalities.
Relationship of fluid intake to voluntary micturitions and urinary incontinence in women
Authors: Wyman Jean F. , Elswick R. K. , Wilson Mary S. , Fantl J. Andrew 
Published: March 2007

AbstractThis retrospective study investigated the relationship between the volume of oral fluid intake and the frequency of voluntary micturitions and urinary incontinent episodes. The sample consisted of 126 community‐dwelling women who were age 55 years or older, ambulatory, mentally intact, and participants in a clinical trial on behavioral management for urinary incontinence. All subjects kept fluid and urinary diaries for 1 week. Analyses of Pearson's correlation coefficients between mean daily oral fluid volume intake and mean daily diurnal and nocturnal micturitions and urinary incontinent episodes were performed in women with sphincteric incompetence alone (N = 89), and those with detrusor instability with or without concomitant sphincteric incompetence (N = 37). The results indicated only weak positive correlations between fluid intake and voluntary micturitions. Similar weak positive correlations were observed with incontinent episodes even after controlling for the effect of diuretic use or urodynamic characterization. Modest positive relationships between fluid intake and the urinary variables were found in subjects with pure sphincteric incompetence. No correlations were found in subjects with detrusor instability. Additional analyses of these relationships suggests that fluid intake may have different effects based on the severity of the incontinence syndrome, and that these effects may vary by pathophysiologic condition. We conclude that the volume of fluid intake does not strongly influence voluntary micturition patterns or frequency of urinary incontinent episodes in community‐dwelling women.
In‐vitro contractile response of the rabbit corpus cavernosa to field stimulation and autonomic agonists and antagonists: A qualitative study
Authors: Broderick Gregory , Hypolite Joseph , Levin Robert M. 
Published: March 2007

AbstractField stimulation of rabbit corporus cavernosum tissue strips can result in relaxation, contraction, or a biphasic response depending on the frequency and the power utilized. In this study we characterized the autonomic components of this response by exposing corporal tissue strips to a variety of autonomic agonists and antagonists including phentolamine, isoproterenol, methoxamine, propranolol, bethanechol, atropine, and ATP. Low frequency electrical field stimulation produced a bi‐phasic response characterized by an initial relaxation followed by a contraction. High frequencies (≥ 32 Hz) produced contraction only. All responses were abolished by tetrodotoxin, indicating that both the contractile and relaxant responses to field stimulation are mediated by complex neural mechanisms. The initial relaxation response involves a combination of mediators which include musca‐rinic cholinergic stimulation, purinergic, beta‐adrenergic, and non‐adrenergic, non‐cholinergic (NANC) stimulation. The non‐cholinergic contribution to corporal smooth muscle relaxation appeared to be approximately equal in significance to the cholinergically mediated relaxation. Beta adrenergic stimulation mediated a direct relaxation of the corporal smooth muscle. The contractile portion of the bi‐phasic response was mediated by alpha‐adrenergic stimulation. Additionally we have noted a rebound contraction following termination of field stimulation at all frequencies that is not affected by adrenergic or cholinergic blockade and may reflect the field‐stimulated release of an endogenous smooth muscle contractile factor.
Effect of narcotic anesthesia and skeletal muscle paralysis on passive and dynamic urethral function of stress continent and incontinent women
Authors: Bump Richard C. , Huang Kou Chu , McClish Donna K. , Fantl J. Andrew , Wein Alan J. 
Published: March 2007

AbstractThe aim of this study was to assess the importance of conscious skeletal muscle activity on the resting and stressed urethral sphincteric mechanism in stress continent and stress incontinent women. We evaluated the effects of loss of consciousness induced by a narcotic‐based general anesthetic technique, with and without concurrent skeletal muscle paralysis, urethral sphincteric function. Nine premenopausal women who underwent vaginal hysterectomy without continence surgery had passive and dynamic urethral pressure profilometry performed within 24 hours before surgery, while asleep and totally paralyzed following endotracheal intubation before the start of surgery, while asleep and totally nonparalyzed at the end of surgery, and at the time of discharge from the hospital on the second or third postoperative day. Five subjects were stress incontinent and four had mild genuine stress incontinence but did not desire continence surgery with their hysterectomy. Measurements analyzed included urethral maximum closure pressure (MUCP) and functional length (FUL) from the passive profiles and bladder to urethra pressure transmission ratios (PTR) for each quarter of the urethra from the dynamic profiles. We found significant attenuation of urethral sphincteric function with stress due to muscle paralysis and loss of consciousness independent of muscle paralysis. Passive urethral function was more significantly depressed by paralysis than by loss of consciousness. These changes were statistically sifnificant only in stress continent subjects and not in the stress incontinent subjects, an observation that supports other evidence suggesting that there are important neuromuscular components in the pathogenesis of stress incontinence.
A comparative study of pelvic floor training and electrical stimulation for the treatment of genuine female stress urinary incontinence
Authors: Hahn Inger , Sommar Solveig , Fall Magnus 
Published: March 2007

AbstractTwenty women with pure genuine stress urinary incontinence were randomly allocated to 6 months of pelvic floor training or intravaginal electrical stimulation. The result was evaluated with a pad test and patients' rating of efficacy. Patients not cured by the first treatment given were offered the other one. A long‐term follow‐up was done 4 years after concluding treatment.The group of patients initially treated with pelvic floor exercises (n = 10) were significantly improved according to the pad test (P < 0.01). This corresponded very well to the subjective result, one patient being cured, five reporting insignificant symptoms, and the remaining four an improvement. The results were similar in patients allocated to intravaginal electrical stimulation (n = 10) (P < 0.05): one patient cured, four having insignificant symptoms, three improved, and two unchanged. We did not find any significant difference of results between the two groups of treatment (P < 0.10). Follow‐up after 4 years in 19 patients revealed that 1 patient was further improved, 8 patients were unchanged and 5 had deteriorated. Five women were operated during the follow‐up period.Pelvic floor training is an adequate method for treatment of stress urinary incontinence. Even patients with severe incontinence may show a very good result. However, a sustained effect presupposes continuing exercise and during the follow‐up period of 4 years a quarter of the patients had to be operated upon to obtain permanent cure. The study also indicated that patients undergoing both treatments were further improved during the second course of treatment.
The relationship between external anal and external urethral sphincter activity in continent women
Authors: Burgio Kathryn L. , Engel Bernard T. , Quilter Reginald E. , Arena Vincent C. 
Published: March 2007

AbstractThe relationship between the external anal sphincter and the periurethral sphincter muscles is an unresolved issue. Recordings of the external anal sphincter (EAS) are commonly used to indicate the responses of the urethral sphincter during urodynamic evaluations and in biofeedback procedures for the treatment of urinary incontinence. This study examined the validity of using anal sphincter training to teach control of the external urethral sphincter. Subjects were 5 continent women, aged 37–51 years, who reported being free of all urologic symptoms. Using visual biofeedback of anal sphincter pressure, subjects were trained to voluntarily contract the sphincter to four amplitudes: 5, 10, 15, and 20 mmHg (6.8, 13.6, 20.4, and 27.2 cmH2O). Then they were guided through a series of controlled anal sphincter contractions, while the response of the urethral sphincter was measured using surface electrodes embedded in a Foley catheter. At each of four bladder volumes, subjects performed 16 contractions (four contractions at each of the four amplitudes). The order of contractions was counterbalanced, using a Latin square design. The results show a strong, statistically significant, monotonic relationship between the magnitude of anal sphincter contraction (pressure) and the level of urethral sphincter electromyographic (EMG) activity. The results support the use of the external anal sphincter as an indicator of urethral sphincter activity for the purpose of conducting biofeedback in the treatment of urinary incontinence.
Handwashing in the cystometric evaluation of detrusor instability
Authors: Mayer Robert , Wells Thelma , Brink Carol , Diokno Ananias , Cockett Abraham 
Published: March 2007

AbstractAmbulatory community living women were evaluated for complaints of urinary incontinence. Diagnostic testing included a detailed history and physical examination, urinalysis, full bladder stress testing, and urodynamic studies consisting of uroflometry, urethropro‐filometry, and provocative water cystometry. Provocative maneuvers included coughing, heel bouncing, and handwashing. Uninhibited contractions were detected during cystometry in 34 of the 112 patients who completed diagnostic testing. The majority (74%) of the 34 patients with detrusor instability demonstrated evidence of uninhibited contractions during the filling phase of cystometry; coughing elicited contractions in 20%, heel bounces in 9%, and handwashing in 68% of patients, respectively. Of the nine patients with detrusor instability who did not have contractions during filling, all nine demonstrated bladder contractions after handwashing, whereas coughing and heel bouncing each elicited contractions in one patient apiece. In 66 patients who had evidence of stress‐related urine loss during the cystometric study, all but one lost urine with coughing but only 14% after handwashing. These findings suggest handwashing may be a sensitive and specific stimulus for detection of detrusor instability during cystometric testing.
The frequency/volume chart in genuine stress incontinent women
Authors: Larsson Gregor , Victor Arne 
Published: March 2007

AbstractUrinary incontinence is a major health problem. Simple methods of investigation are thus of great interest. For example, the frequency/volume chart is in common use, but the efficiency of this instrument in characterizing different conditions of incontinence does not seem to have been scrutinized.In this study the frequency/volume charts of 81 genuine stress incontinent women are compared to those of 151 women without complaints from the lower urinary tract. The total voided volume, the frequency of micturition, the largest single voided volume, and the variability of voided volumes are all shown to be statistically different in the genuine stress incontinent material from that of the normal material. If this is of importance from a differential diagnostic viewpoint is uncertain, as the overlap between the materials for all parameters is great.
Effects of acid‐base changes on rabbit urinary bladder contractility
Authors: Tong Yat‐Ching , Wein Alan J. , Levin Robert M. 
Published: March 2007

AbstractAlterations in the pH of the in vitro bathing medium can effect intracellular pH and thus alter the contractile response of smooth muscle preparations to various forms of stimulation. The mucosal surface of the urinary bladder provides a barrier to most solutes within the bladder. The purpose of this study was to determine if alterations in the intravesical pH would affect the contractile response to field stimulation.The in vitro whole rabbit bladder model was used to study the effect of changing intravesical pH on bladder contractility. Contrary to previous studies on isolated muscle strips, the results of the present study show that under different pH conditions (pH 4.0–8.0), no significant changes were observed in intravesical pressure generation with field stimulation, nor in the rate of the pressure generation. An intact bladder mucosa appears to be an effective barrier against the physiological effects of altered intravesical pH on bladder smooth muscle contraction.
Pressure measurements during pelvic floor muscle contractions: The effect of different positions of the vaginal measuring device
Authors: Bø Kari 
Published: March 2007

AbstractThe purpose of the present investigation was to assess whether different positions of the vaginal measuring device affect the pressure readings during pelvic floor muscle (PFM) contraction.Twelve women with stress urinary incontinence (SUI) participating in a PFM exercise program, volunteered for the study. The diagnosis of SUI was based on urodynamic investigation and pad test. The mean age of the women was 40.9 years (24–50).The women performed three PFM contractions with a vaginal balloon placed in four different positions: 1) against the vaginal vault and in the posterior fornix, 2) in the proximal upper third of the vagina, 3) with the middle of the balloon 3.5 cm from the introitus vagina and 4) with half of the balloon outside the introitus vagina.The results demonstrated significant differences between recordings from the four vaginal positions: position 1, median pressure 5 cm H2O; position 2, 9 cm H2O; position 3, 15 cm H2O; and position 4, 8 cm H2O.It is concluded that the position of the vaginal device affects the results. This may be one important factor which could explain the variability of vaginal pressure recordings during PFM contractions. For most women the highest pressure was recorded in position 3. © 1992 Wiley‐Liss, Inc.
New method of measuring uroflow in the rat bladder
Authors: Chancellor Michael B. , Blaivas Jerry G. , Levin Robert M. , Kaplan Steven A. , Otter Mark W. , Schussler George 
Published: March 2007

AbstractUrodynamic evaluation of bladder function requires the simultaneous measurement of detrusor pressure and uroflow. Although the rat is a common animal model to study several bladder dysfunctions, including partial outlet obstruction, one of the major problems is that the bladder capacity has been too small for the measurement of uroflow. We have developed a new method of measuring uroflow in the rat that is sensitive at low bladder volumes. The method is based on the change in conductance of the gap between two silver electrodes in a measuring chamber as the chamber fills with saline during voiding. An AC voltage supply drives a current through the saline. As the saline level rises in the chamber the conductance increases, with a corresponding increase in current flow. A linear correlation between time rate of change of electrical current and fluid flow rate exists over a wide range of values and suggests that this new rat flowmeter is both accurate and reproducible. © 1992 Wiley‐Liss, Inc.
Continuous monitoring of micturition pattern in nonhuman primates: Similarities to humans
Authors: Shoukry Mohamed Shafik , Ghoniem Gamal M. 
Published: March 2007

AbstractMost experimental urodynamic studies have been carried out in animals under anesthesia. This study is performed on awake, unrestrained, upright animal models phylogenetically similar to humans. Five female rhesus monkeys were monitored for their micturition pattern using the system described in Part I. The voiding frequency, physiologic diuresis, and the early voiding correspond well to those of humans. A peak flow nomogram was constructed based on 357 urinations. It depicts a non‐linear relation of peak flow to increasing voided volume. The nomogram is similar in pattern to those developed for humans.These findings suggest that the rhesus monkey is one of the best animal models to study the function of lower urinary tract. © 1992 Wiley‐Liss, Inc.
Bladder function in patients with myotonic dystrophy
Authors: Bernstein Inge Thomsen , Andersen Birgitte Bo , Andersen Jens Thorup , Arlien‐øborg Peter 
Published: March 2007

AbstractTen patients with a clinically and neurophysiologically established diagnosis of myotonic dystrophy underwent urodynamic evaluation of the lower urinary tract. Eighty percent of the patients had urinary complaints by history, but we were not able to identify a homogeneous bladder dysfunction pattern by voiding and incontinence chart, flowmetry, cystometry, or sphincter electromyography. © 1992 Wiley‐Liss, Inc.
Early molecular response to rabbit bladder outlet obstruction
Authors: Buttyan Ralph , Jacobs Benjamin Z. , Blaivas Jerry G. , Levin Robert M. 
Published: March 2007

AbstractPartial obstruction of the rabbit bladder outlet induces a rapid hypertrophy characterized by increased bladder weight and smooth muscle content in addition to increased collagen deposition. In experiments designed to examine the genetic basis of this response, we evaluated the expression of a multitude of gene products in the rabbit bladder during the first 48‐hr period following placement of a urethral cuff blocking the rabbit bladder outlet by 90%. Individual bladders were obtained from unoperated rabbits, from sham‐operated rabbits and from rabbits at 2, 6, 10, 24, and 48 hr after obstruction. Poly (A)+ mRNA was extracted from each of these tissues and Northern blots made from the RNAs were hybridized repeatedly with a series of probes. Corrected densitometry was utilized to assign a value to each transcript and to follow the change in expression of a given gene product over time.Although several of the gene products we analyzed for were undetectable or unchanged over this brief period, we were able to detect a substantial sustained increase in the 4.5 kb mRNA encoding basic fibroblast growth factor (bFGF) initiated by 2 hr after obstruction. Later, at 6–24 hr, we measured transient induction of transcripts encoding c‐myc, heat shock 70K (hsp‐70), Ha‐, and N‐ras. In contrast, the constitutively‐expressed 2.4 kb transcript for transforming growth factor‐β (TGF‐β) transiently declined to 50% of control levels at 24 hr following obstruction. In summary, our results provide a picture of tissue in transition, with synthesis of certain growth‐stimulating and stress‐response products (bFGF, myc, ras, and hsp‐70) increasing and a growth‐inhibitory substance (TGF‐β) decreasing. © 1992 Wiley‐Liss, Inc.
Effect of different anaesthetics, routes of catheterisation, age, and filling rate on the urodynamics of the guinea‐pig
Authors: Macneil H. F. , Williams J. H. , Brading A. F. 
Published: March 2007

AbstractThis study compared the effects of two anaesthetic regimens, ketamine 66 mg/kg with xylazine 2.5 mg/kg and urethane 1.25 g/kg, on the urodynamic parameters of the guineapig. In addition, the effects of advancing age, different filling rates (0.25 and 0.5 ml/min) and different routes of cannulation of the bladder (urethral and suprapubic) upon urodynamic parameters were studied.There was a larger cystometric capacity under urethane than with ketamine and xylazine anaesthesia in both young and old animals.Older animals had a larger cystometric capacity under ketamine and xylazine anaesthesia and a higher pressure threshold (Pthreshold) for micturition under urethane.The higher filling rate, 0.5 ml/min, caused a higher Pthreshold under ketamine and xylazine anaesthesia.There was a significantly higher voiding pressure with the urethral catheter in place, than with a suprapubic catheter alone. There was also a lower Pthreshold when recording with a suprapubic catheter than with a urethral catheter under ketamine and xylazine anaesthesia (5.4 vs. 1.8 cm H2O).Interpretation of the results from anaesthetised small animal models should take into account the age of the animal, the anaesthetic used and the route by which the various parameters are measured. © 1992 Wiley‐Liss, Inc.
Membrane electrical properties of guinea pig bladder smooth muscle with growth
Authors: Seki Narihito , Karim Omer M. A. , Mostwin Jacek L. 
Published: March 2007

AbstractThe effect of growth on bladder membrane electrical properties was studied in guinea pigs. The electrical activity of the smooth muscle membrane in dertusor muscle strips from immature (6–8 wk) and mature (22–24 wk) guinea pigs was investigated using an intracellular microelectrode technique. The parameters measured included resting membrane potential, membrane time constant, and the action potential (AP) kinetics. The results of this study can be summarized as follows: 1) Bladder weight increased with animal growth. 2) Growth did not affect the detrusor smooth muscle resting membrane potential or membrane time constant. 3) The configuration of the detrusor muscle AP (amplitude, after hyperpolarization, and overshoot potential) and indices of AP kinetics (maximum velocities of depolarization and repolarization) were similar in immature and mature animals. The AP duration, however, showed slight prolongation in the mature adult group. These results indicate that, in the guinea pig, the passive and active electrical properties of the detrusor smooth muscle membrane do not change significantly with growth. © 1992 Wiley‐Liss, Inc.