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AIMS: During filling cystometry, urethral pressure variations (UPV) can be observed. The clinical relevance and a clear definition of this phenomenon are still a matter of debate. For further research and definition of UPV, it is important to determine how this condition can best be demonstrated. The purpose of this study is to compare continuous urethral pressure measurements with a single urethral-sensor catheter and a triple urethral-sensor catheter in demonstrating UPV. METHODS: Seventy-five adult female patients requiring urodynamic investigation enrolled in this prospective study. All patients underwent two series of filling and voiding cystometry. One series was performed with a dual-air balloon sensor urodynamic catheter, the other series with a triple urethral-sensor catheter. UPV were defined as urethral pressure drop exceeding 30 cmH2O. RESULTS: The prevalence of UPV was 37.3% (28 out of 75 patients), more common than detrusor overactivity. The triple urethral-sensor catheter was more sensitive than the single urethral-sensor catheter: In eight patients UPV were demonstrated with both catheters and in 18 patients only in the measurement with the triple urethral-sensor catheter. This difference in detection was significant (P < .001). CONCLUSION: There is an additional value in measurement with the triple urethral-sensor catheter for demonstration of UPV during filling cystometry. Currently, continuous measurement of urethral pressure during filling cystometry and UPV is not defined within International Continence Society terminology. The single urethral-sensor catheter is useful for a start, however, it demonstrates less than half of all UPV.
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Uretra/fisiología , Catéteres Urinarios , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión , Estudios Prospectivos , Uretra/fisiopatología , Vejiga Urinaria Hiperactiva/fisiopatología , Urodinámica , Adulto JovenRESUMEN
The role of urethral pressure variations during filling cystometry is seldom assessed as a potential cause of voiding dysfunction and/or storage disorders. In this article, we review current research in the field of urethral pressure variations and discuss the way of determining urethral pressure variations, its value for the clinical practice and hypothesize the origin of urethral pressure variations. The observation and recognition of urethral pressure variations (urethral instability) could be valuable in the diagnosis and evaluation of therapy in functional lower urinary tract disorders.
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Uretra/fisiopatología , Humanos , Presión , Terminología como Asunto , Enfermedades Uretrales/complicaciones , Enfermedades Uretrales/fisiopatología , UrodinámicaRESUMEN
OBJECTIVE: Clinical efficacy and urodynamic changes in women treated by extracorporeal magnetic innervation therapy (ExMI) were studied. MATERIAL AND METHODS: Women, presenting with urge, stress and mixed urinary incontinence, were included in a prospective study. ExMI was applied by an electromagnetic chair. To document clinical efficacy, a voiding diary and visual analogue scale were completed before and after treatment, together with a pad test. Detrusor overactivity (DO) and urethral instability (URI) were urodynamically documented. Clinical success was defined as more than 50% improvement in symptoms. RESULTS: Sixteen patients were included. At baseline, DO was observed in 10 patients, and URI in 12 patients. DO did disappear at follow-up in 60%, and a decrease in URI was seen in 66%. No significant clinical improvement was seen at follow-up. CONCLUSION: Although significant changes in urodynamic variables were observed, no significant improvement in clinical efficacy was seen after ExMI.
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Magnetoterapia/instrumentación , Vejiga Urinaria Hiperactiva/terapia , Incontinencia Urinaria/terapia , Adulto , Anciano , Femenino , Humanos , Contracción Isométrica/fisiología , Persona de Mediana Edad , Diafragma Pélvico/inervación , Diafragma Pélvico/fisiopatología , Estudios Prospectivos , Vejiga Urinaria Hiperactiva/fisiopatología , Incontinencia Urinaria/fisiopatología , Urodinámica/fisiologíaRESUMEN
PURPOSE: Urodynamic parameters that predict the outcome of sacral nerve stimulation are difficult to define. We studied the predictive value of urethral instability and other urodynamic parameters on the efficacy of sacral nerve stimulation. MATERIALS AND METHODS: Patients with refractory voiding disorders were implanted with a neurostimulator after responding with more than 50% improvement in main symptoms after percutaneous nerve evaluation. Filling cystometry was performed with 3 urethral sensors and 1 bladder sensor at baseline and 6 months after implantation. Urethral pressure variations more than 15 cm H(2)O were considered pathological and defined as urethral instability. Clinical efficacy was evaluated by voiding diary data and defined as successful when greater than 50% improvement was observed. RESULTS: A total of 19 female patients enrolled in the study. At baseline detrusor overactivity was observed in 9 patients, while 18 showed urethral instability. Sacral nerve stimulation therapy was successful in 13 patients (68%). The number of pads used per day and the severity of leakage decreased significantly. Of the 13 successfully treated patients 12 showed urethral instability at baseline. Detrusor overactivity was present in 4 successfully treated patients. Urethral instability disappeared in 7 of the 13 successfully treated patients and detrusor overactivity disappeared in only 1 of these patients. CONCLUSIONS: In this study urethral instability appeared to be a valuable urodynamic parameter for predicting the outcome of sacral nerve stimulation.
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Terapia por Estimulación Eléctrica/instrumentación , Plexo Lumbosacro/fisiopatología , Prótesis e Implantes , Uretra/fisiopatología , Vejiga Urinaria Hiperactiva/fisiopatología , Urodinámica/fisiología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Uretra/inervación , Vejiga Urinaria/inervación , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Hiperactiva/terapia , Incontinencia Urinaria de Urgencia/fisiopatología , Incontinencia Urinaria de Urgencia/terapiaRESUMEN
OBJECTIVE: To evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women. PATIENTS AND METHODS: FMS was provided by a 'magnetic chair'; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction. RESULTS: In 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001). CONCLUSION: FMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.
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Estimulación Eléctrica/métodos , Magnetismo/uso terapéutico , Incontinencia Urinaria/terapia , Femenino , Humanos , Estudios Prospectivos , Incontinencia Urinaria/fisiopatología , UrodinámicaRESUMEN
OBJECTIVE: This study evaluates the patients' judgement of the surgical outcome of the plication procedure, as described by Schröder and Essed, and the postoperative sexual functioning of patients with congenital curvatures and Peyronie's disease. PATIENTS AND METHODS: Of 98 patients treated for penile curvatures between 1985 and 1996, 85 patients received postoperatively a 'Questionnaire Assessing the Outcome of Surgery' and a short version of the 'Questionnaire for Screening Sexual Dysfunctions'. RESULTS: 28 patients with congenital curvatures and 31 with Peyronie's disease were evaluated. 75% of the patients with congenital curvatures and 58% of the patients with Peyronie's disease were satisfied with the result. Patients treated for Peyronie's disease reported diminished penile length and inability to have sexual intercourse more often than patients with congenital curvatures (90 vs. 64%, and 29 vs. 0%). After correction for age, patients with Peyronie's disease were less satisfied with their present sex life, had more frequent erectile problems and more trouble with considerable sexual desire than a group of 42 controls. For patients with Peyronie's disease satisfaction with the result was positively correlated with satisfaction with their present sex life and negatively correlated with the frequency of erectile problems. For patients with congenital curvatures satisfaction with the result was negatively correlated with both a postoperative curvature and a repeat operation. CONCLUSIONS: Some patients with Peyronie's disease may not benefit from surgical correction (alone). Because of the occurrence of sexual problems, future evaluation of the role of pre- and postoperative sexological counselling in achieving better results is recommended.
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Coito , Induración Peniana/cirugía , Pene/anomalías , Pene/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Before septation the entire atrioventricular canal is connected with the ventricular inlet segment (primitive left ventricle) whereas the mature heart exhibits an exclusive connection of the right atrium to the right ventricle. The process which is responsible for this change is controversial. METHODS: Graphic reconstructions of serially sectioned embryonic rat hearts as well as scanning electron micrographs of similar specimens were made. RESULTS: The first indication of a right atrioventricular connection was seen as a groove in the atrioventricular junctional myocardium to the right of the inferior endocardial cushion. This groove expanded to form the right ventricular inlet portion. The right, inferior, and superior walls of this newly formed cavity were formed from junctional myocardium, which demarcated it from the trabeculated right ventricular portion in all developmental stages. The left wall equally developed from this junctional myocardium and formed the ventricular inlet septum. The junctional myocardium between right ventricular inlet and trabeculated portions was seen to develop into the tricuspid valve and its tension apparatus. CONCLUSIONS: The preseptation embryonic heart has no inlet portion to the right ventricle. This new cavity is created by remodelling of atrioventricular junctional myocardium. This myocardium also provides the material contribution to the tricuspid valve and its tension apparatus. Malformations of the right ventricular inlet portion and of the tricuspid valve are indissolubly linked.